A Masked Marauder: Hepatitis C Neuropathy

Published:September 04, 2017DOI:
      When a 52-year-old man presented with burning pain in his feet, his type 1 diabetes, albeit well controlled, was initially thought to be the cause. In fact, a previously undiagnosed infection was to blame. The patient first presented to an outside hospital, where he reported that pain had started over his left heel and then spread to the rest of his left foot, his ankle, and his calf over the course of a few days. Two months later, his right foot was also involved. Aside from diabetes, he had a history of melanoma, for which he had been treated 4 years earlier. Electromyography and a nerve conduction study showed a sensorimotor axonal neuropathy involving the lower extremities. This was attributed to the underlying diabetes.
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        • Brouet J.C.
        • Clauvel J.P.
        • Danon F.
        • Klein M.
        • Seligmann M.
        Biologic and clinical significance of cryoglobulins. A report of 86 cases.
        Am J Med. 1974; 57: 775-788
        • Adinolfi L.E.
        • Utili R.
        • Attanasio V.
        • et al.
        Epidemiology, clinical spectrum, and prognostic value of mixed cryoglobulinaemia in hepatitis C virus patients: a prospective study.
        Ital J Gastroenterol. 1996; 28: 1-9
        • Lunel F.
        • Musset L.
        • Cacoub P.
        • et al.
        Cryoglobulinemia in chronic liver diseases: role of hepatitis C virus and liver damage.
        Gastroenterology. 1994; 106: 1291-1300
        • Dammacco F.
        • Sansonno D.
        Therapy for hepatitis C virus-related cryoglobulinemic vasculitis.
        N Engl J Med. 2013; 369: 1035-1045
        • Zignego A.L.
        • Wojcik G.L.
        • Cacoub P.
        • et al.
        Genome-wide association study of hepatitis C virus- and cryoglobulin-related vasculitis.
        Genes Immun. 2014; 15: 500-505
        • Nemni R.
        • Sanvito L.
        • Quattrini A.
        • Santuccio G.
        • Camerlingo M.
        • Canal N.
        Peripheral neuropathy in hepatitis C virus infection with and without cryoglobulinaemia.
        J Neurol Neurosurg Psychiatry. 2003; 74: 1267-1271
        • Cacoub P.
        • Renou C.
        • Kerr G.
        • et al.
        Influence of HLA-DR phenotype on the risk of hepatitis C virus-associated mixed cryoglobulinemia.
        Arthritis Rheum. 2001; 44: 2118-2124
        • Lenzi M.
        • Frisoni M.
        • Mantovani V.
        • et al.
        Haplotype HLA-B8-DR3 confers susceptibility to hepatitis C virus-related mixed cryoglobulinemia.
        Blood. 1998; 91: 2062-2066
        • Curry M.P.
        • Golden-Mason L.
        • Doherty D.G.
        • et al.
        Expansion of innate CD5pos B cells expressing high levels of CD81 in hepatitis C virus infected liver.
        J Hepatol. 2003; 38: 642-650
        • Agnello V.
        • Abel G.
        Localization of hepatitis C virus in cutaneous vasculitic lesions in patients with type II cryoglobulinemia.
        Arthritis Rheum. 1997; 40: 2007-2015
        • De Vita S.
        • Quartuccio L.
        • Isola M.
        • et al.
        A randomized controlled trial of rituximab for the treatment of severe cryoglobulinemic vasculitis.
        Arthritis Rheum. 2012; 64: 843-853
        • Bonacci M.
        • Lens S.
        • Londoño M.C.
        • et al.
        Virologic, clinical, and immune response outcomes of patients with hepatitis C virus-associated cryoglobulinemia treated with direct-acting antivirals.
        Clin Gastroenterol Hepatol. 2017; 15 (e1): 575-583