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Hepatitis C Virus Associated Cryoglobulinemic Neuropathy Successfully Treated with Plasma Exchange
Author(s) -
Murai Hiroyuki,
Inaba Shoichi,
Kira Junichi,
Yamamoto Akifumi,
Ohno Masaharu,
Goto Ikuo
Publication year - 1995
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.1995.tb02337.x
Subject(s) - cryoglobulinemia , cryoglobulin , cryoglobulins , rheumatoid factor , medicine , mononeuritis multiplex , plasmapheresis , hepatitis c virus , titer , nerve conduction velocity , gastroenterology , pathology , antibody , virus , immunology , vasculitis , disease
A 28‐year‐old Japanese woman who suffered from mononeuritis multiplex was admitted to our hospital. Serological study revealed cryoglobulinemia (type III), hypocomplementemia, high titers of rheumatoid factor (RF), and positive antihepatitis C virus (HCV) antibody. Nerve conduction velocities were slower in sensory nerves than in motor nerves. Biopsied sural nerve showed a marked decrease of myelinated fibers but no evidence of angitis. She received plasma exchange and cryoglobulinpheresis over a period of 2 months with approximately 2.0 L (40 ml/kg) of plasma replaced in each procedure. Both plasma exchange and cryoglobulinpheresis alleviated clinical symptoms, and nerve conduction velocities were improved in several nerves. The serum cryoglobulin level was markedly reduced after the treatment together with the recovery of the C4 level. Thus, complements appeared to be consumed in large quantities in the presence of cryoglobulinemia in this patient. Efficacy of cryoglobulinpheresis indicates the possibility that cryoglobulins produced in association with HCV infection played a role in damaging the nerve directly through the activation of the complement system.