Yonsei Med J.  2012 Jul;53(4):856-858. 10.3349/ymj.2012.53.4.856.

A Case of Acute Disseminated Encephalomyelitis Associated with Hepatitis C Virus Infection

• Sim JE
• Lee JB
• Cho YN
• Suh SH
• Kim JK
• Lee KY

• KMID: 1716889
• DOI: http://doi.org/10.3349/ymj.2012.53.4.856

Abstract

Acute disseminated encephalomyelitis (ADEM) is a monophasic autoimmune demyelinating disease of the central nervous system, which typically follows acute viral or bacterial infection or vaccination. We report a case of ADEM associated with hepatitis C virus (HCV) infection with positive serum and cerebrospinal fluid (CSF) anti-HCV antibody. After steroid treatment, neurologic symptoms were improved. Virus triggers autoimmunity or direct viral invasion plays a part in the genesis of ADEM. This is the first reported case of ADEM with anti-HCV antibody in the CSF.

Keyword

Acute disseminated encephalomyelitis; hepatitis C virus; autoimmunity; direct viral invasion; anti-HCV antibody

MeSH Terms

Encephalomyelitis, Acute Disseminated/*diagnosis/drug therapy/etiology/virology
Female
Hepacivirus/pathogenicity
Hepatitis C/*complications
Humans
Methylprednisolone/therapeutic use
Middle Aged

Figure

• 

  Fig. 1 FLAIR axial and contrast-enhanced T1-weighted axial images of brain MRI (A) and T2-weighted sagittal image of spine MRI on admission (B). (A) T2-high signal lesion with peripheral rim enhancement was noted in the brainstem. (B) Multifocal T2-high signal lesion on the brainstem and the cervical spinal cord. MRI, magnetic resonance imaging; FLAIR, fluid attenuated inversion recovery.

• 

  Fig. 2 FLAIR axial and contrast-enhanced T1-weighted axial images of brain MRI (A) and T2-weighted sagittal image of spine MRI (B) at follow-up two months later. (A) Remaining abnormal signal foci and no more enhanced lesion of the brainstem. (B) Nearly complete recovery of abnormal signal foci of the cervical spinal cord. MRI, magnetic resonance imaging; FLAIR, fluid attenuated inversion recovery.

Reference

1. Sacconi S, Salviati L, Merelli E. Acute disseminated encephalomyelitis associated with hepatitis C virus infection. Arch Neurol. 2001. 58:1679–1681.

2. Tan H, Kiliçaslan B, Onbaş O, Büyükavci M. Acute disseminated encephalomyelitis following hepatitis A virus infection. Pediatr Neurol. 2004. 30:207–209.

3. Alehan FK, Kahveci S, Uslu Y, Yildirim T, Yilmaz B. Acute disseminated encephalomyelitis associated with hepatitis A virus infection. Ann Trop Paediatr. 2004. 24:141–144.

4. Kang W, Shin EC. Clinical implications of chemokines in acute and chronic hepatitis C virus infection. Yonsei Med J. 2011. 52:871–878.

5. Dawson TM, Starkebaum G. Isolated central nervous system vasculitis associated with hepatitis C infection. J Rheumatol. 1999. 26:2273–2276.

6. Origgi L, Vanoli M, Carbone A, Grasso M, Scorza R. Central nervous system involvement in patients with HCV-related cryoglobulinemia. Am J Med Sci. 1998. 315:208–210.

7. Propst T, Propst A, Nachbauer K, Graziadei I, Willeit H, Margreiter R, et al. Papillitis and vasculitis of the arteria spinalis anterior as complications of hepatitis C reinfection after liver transplantation. Transpl Int. 1997. 10:234–237.

8. Bolay H, Söylemezoğlu F, Nurlu G, Tuncer S, Varli K. PCR detected hepatitis C virus genome in the brain of a case with progressive encephalomyelitis with rigidity. Clin Neurol Neurosurg. 1996. 98:305–308.

9. Annunziata P, Marroni M, Francisci D, Stagni G. Acute transverse myelitis and hepatitis C virus. Infez Med. 2005. 13:45–47.

10. De Carli DM, Pannebeker J, Pedro FL, Haygert CJ, Hertz E, Beck Mde O. Transverse myelitis associated to HCV infection. Braz J Infect Dis. 2009. 13:147–152.

11. Menge T, Hemmer B, Nessler S, Wiendl H, Neuhaus O, Hartung HP, et al. Acute disseminated encephalomyelitis: an update. Arch Neurol. 2005. 62:1673–1680.