מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – Acute disseminated encephalomyelitis may be the first manifestation of hepatitis C viral infection, according to report in the October issue of the Archives of Neurology by physicians who describe what they believe to be the first such case.
Dr. Sabrina Sacconi, currently at Columbia University in New York, and colleagues in Italy describe the case of a 46-year-old woman who presented with a sudden onset of occipital headache and generalized seizures. The patient was admitted to the Department of Neurology at the Policlinico of Modena.
She alternated between stupor and psychomotor agitation, and showed mild right hemiparesis and hemianopsia. MRI showed extensive, symmetric and confluent abnormalities.
Fifty days before, the patient had received multiple blood transfusions after a duodenal ulcer perforation. Serologic testing at that time was negative for hepatitis C. However, during the current episode, tests for hepatitis C antibodies and RNA were highly positive, indicating recent infection.
Intravenous dexamethasone treatment was started and at 7 days after admission MRI abnormalities "were remarkably reduced in number and size," the clinicians write. Five months later, clinical and neuroradiological signs had completely resolved, and 2 years of follow-up revealed no relapses.
"Thus, it appears that our patient had immune-mediated CNS damage associated with hepatitis C virus infection…directed mainly against myelin," Dr. Sacconi and her colleagues conclude. Based on this case, they recommend the inclusion of hepatitis C screening for patients who present with acute disseminated encephalomyelitis.
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