Abstract Details

Title Vasculitic Neuropathy Associated with Concomitant Active Hepatitis C and B

Topic Peripheral Nerve

Presentation(s) P07 - (-)

Poster/Presentation
Number 059

Objective

Background BACKGROUND: Infectious hepatitis associated with vasculitis generates severe morbidity in most cases. The situation of concomitant active hepatitis without or with necrotizing vasculitis is quite possible due to their common way of transmission. However, consensus regarding treatment of vasculitis is lacking.

Design/Methods DESIGN/METHODS: 51 year-old woman presented with six-weeks of severe burning pain in limbs and stepwise impairment of different peripheral nerves. At presentation, she had severe rather symmetrical bilateral flail foot and severe weakness of hands and forerams with mild weakness of quadriceps and hamstrings. Sensation to all modalities was impaired in stocking and gloves distributions. Reflexes were depressed throughout. She was unable to use her hands or stand. Due to stepwise presentation, vasculitic neuropathy was suspected.

Results RESULTS: Laboratory revealed mildly impaired transaminases, elevated sedimentation rate(94), C-reactive protein(15), cryoglobulins(trace) with active hepatitis B (+IgManti-core and DNA) and Hepatitis C (+IgG and high RNA titers). EMG was consistent with a subacute severe sensorimotor polyneuropathy with abundant fibrillation potentials. Nerve biopsy revealed necrotizing vasculitis. Attempts to differentiate between hepatitis B versus C vasculitis could not be made pathologically. Patient was treated with plasma exchanges and high dose corticosteroids. Treatment with rituximab followed by alpha interferon are being planned.

Conclusions CONCLUSIONS: This case of vasculitic neuropathy associated with concomitant active Hepatitis C and B posed an unusual diagnostic and therapeutic challenge since both viruses may be associated with this entity. Differentiating the exact infectious trigger of this vasculitic disorder is likely important because of therapeutic and prognostic differences.

Authors/Disclosures
Ezequiel A. Piccione, MD, FAAN (UNMC) PRESENTER	Dr. Piccione has nothing to disclose.
Karim Salame, MD (Memorial Healthcare System)	Dr. Salame has nothing to disclose.
Bashar Katirji, MD, FAAN (University Hospitals Cleveland Medical Ctr- Case Western Reserve University)	Dr. Katirji has nothing to disclose.
Gavin Giovannoni, MD (QMUL)	Dr. Giovannoni has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Merck KGaA. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche-Genentech. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Moderna. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sandoz. Dr. Giovannoni has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Astoria Biologica. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Zenas. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Giovannoni has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Giovannoni has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Medscape.
	No disclosure on file

��ɫ��

��ɫ��