LETTER
Extrahepatic Manifestations of Hepatitis C Virus Infection
Tjaard U. Hoogenraad, MD;
Gerard H. Jansen, MD; and
Jan van Hattum, MD
15 August 1996 | Volume 125 Issue 4 | Page 345
TO THE EDITOR:
In their review of the extrahepatic manifestations of HCV infection, Gumber and Chopra [1] did not mention the possible association between HCV and progressive multifocal leukoencephalopathy (PML). Pearce and colleagues [2] first proposed this association, but thus far their observation has not been confirmed.
We describe a 62-year-old male dentist who had a 6-year history of chronic hepatitis C and cirrhosis. Within a few months, the patient became severely confused, aphasic, and demented. Magnetic resonance imaging showed large white-matter lesions in the frontal lobe. Examination of a biopsy specimen obtained from this area showed abnormal astrocytes with oddly shaped nuclei. Abnormal nuclei in astrocytes can be found in patients with Wilson disease [3], portosystemic encephalopathy, PML, and malignant glial tumors [4]. A definitive diagnosis of PML was made when the JC virus was detected in the astrocytes by in situ hybridization [4].
Progressive multifocal leukoencephalopathy is an uncommon disease that occurs in late adulthood and evolves over a period of weeks to months. Aphasia, dementia, and confusional states are typical manifestations. The disorder is caused by infection with papovavirus and rarely occurs independently. The condition primarily develops in immunocompromised patients, and a high incidence has been noted in patients with the acquired immunodeficiency syndrome. Progressive multifocal leukoencephalopathy may also develop in patients with various chronic diseases such as lymphocytic leukemia, Hodgkin disease, sarcoidosis, and liver cirrhosis [4].
We believe that PML should be considered as one of the possible extrahepatic manifestations of HCV infection and propose that patients with hepatitis C and signs of encephalopathy have computed tomography or magnetic resonance imaging to test for the presence of areas of leukoencephalopathy. Conversely, immunocompetent patients with PML should be tested for HCV infection.
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Author and Article Information
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University Hospital, Utrecht 3508 GA, the Netherlands
1. Gumber SC, Chopra S. Hepatitis C: a multifaceted disease. Review of extrahepatic manifestations. Ann Intern Med. 1995; 123:615-20.
2. Pearce DA, Wong V, Miloszewski KJ. Hepatitis C: a novel cause of progressive multifocal leucoencephalopathy. Br J Hosp Med. 1993; 50:193.
3. Von Ho ß lin C, Alzheimer A. Ein Beitrag zur Klinik und pathologischen Anatomie der Westphal-Strumpellschen Pseudosclerose. Zeitschr Gesamte Neurol Psychiatr. 1912; 8:183-209.
4. Aksamit AJ. Nonradioactive in situ hybridization in progressive multifocal lcukoencephalopathy. Mayo Clin Proc. 1993; 68:899-910.
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