Clinical

Cryoglobulinemia predicts more severe neuropathy in HCV-infected patients

Last Updated: 2003-09-29 16:31:39 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Cryoglobulinemia is associated with more severe and widespread peripheral neuropathy in hepatitis C virus (HCV)-infected patients, according to a report published in the September issue of the Journal of Neurology, Neurosurgery, and Psychiatry.

The authors point out that cryoglobulinemia (CG) often occurs in HCV infection, and that peripheral neuropathy is a fairly common complication.

The current findings are based on a study of 51 HCV-infected patients who were tested for CG and for the presence of peripheral neuropathy. Sural nerve biopsy was performed in 28 of these patients to obtain a specimen for neuropathologic analysis.

Forty patients (78%) were found to have CG, Dr. Raffaello Nemni, from the University of Milan in Italy, and colleagues report. Moreover, CG was found to be a significant predictor for polyneuropathy (p = 0.01), rheumatoid factor positivity (p < 0.001), and low C4 levels (p = 0.001).

In the biopsy subgroup, epineurial vasculitis was seen in 8 of 25 (32%) samples from CG+ patients and in 2 of 3 (66%) samples from CG- patients. Differential fascicular loss of axons was noted in 10 (40%) of the CG+ samples and in 1 (33%) of the CG- samples. Signs of demyelination and axonal degeneration were observed in 7 (28%) of the CG+ samples and in none of the CG- samples.

Histometrical analysis also revealed more severe neuropathy in CG+ patients, the researchers point out.

"Morphological findings in the sural nerve from HCV CG- and CG+ (cases) are consistent with an ischemic mechanism of nerve damage," the team writes, "and are against a direct role of the virus in causing the associated peripheral neuropathy."

J Neurol Neurosurg Psychiatry 2003;74:1267-1271.