Transverse myelitis associated with chronic viral hepatitis c


Leila Mouelhi
Hayfa Mekki
Fatma Houissa
Radhouan Debbeche
Majd Ben Rejeb
Slim Bouzaidi
Sinda Trabelsi
Mohamed Salem
Taoufik Najjar


Background: HCV infection could cause several extra hepatic diseases including mixed cryoglobulinemia. Peripheral neuropathy is the most common complication of mixed cryoglobulinemia. In addition to cryoglobulinemia’s neuropathy, transverse myelitis had been related to hcv infection.
Aim : But causality of this association is not clearly established.
Case report: A 55-year-old man presented with motor deficiency in lower extremities and urinary retention .Neurological exams showed a spastic paraparesis and proprioceptive ataxia. Spinal MRI revealed a contrast enhancing signal abnormality within the spinal cord extending from Levels C3 to C5. Serology hepatitis C and viremia were positive. Clinical diagnosis of acute demyelinating sensorimotor polyneuropathy associated to chronic hepatitis C was etablished.
Conclusion: Screening of HCV infection must be done in patients with transverse myelitis and no clear aetiology.


Transverse myelitis, Chronic viral hepatitis C



  1. McMurray RW, Elbourne K. Hepatitis C virus infection and autoimmunity. Semin Arthritis Rheum 1997;26:689-701.
  2. 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;74:1264-1271.
  3. Casato M, Saadoun D, Marchetti A et al. Central nervous system involvement in hepatitis C virus cryoglobulinemia vasculitis : a multicenter case-control study using magnetic resonance imaging and neuropsychological tests. J Rheumatol 2005;32:484-488.
  4. Mestre TA, Correia de Sa J, Pimentel J. Multifocal central and peripheral demyelination associated with hepatitis C virus infection. J Neurol 2007;254-1754-1756.
  5. Zandman-Goddard G, Levy Y, Weiss P, Shoenfeld Y, Langevitz P. Transverse myelitis associated with chronic hepatitis C. Clin Experiment Rheumatol 2003;21:111-113.
  6. Grewal AK, Lopes MB, Berg CL, Bennett AK, Alves VAF, Trugman JM. Recurrent demyelinating myelitis associated with hepatitis C viral infection. J Neurol Sci 2004;224:101-106.
  7. Nolte CH, Endres AS, Meisel H. Sensory ataxia in myelopathy with chronic hepatitis C virus infection. Neurology 2002;59:958.
  8. Craxi A, Laffi G, Zignego AL. Hepatitis C virus infection: a systemic disease. Mol Aspects Med 2008;29:85-95.
  9. Chad D, Parisier K, Bradley WG et al. The pathogenesis of cryoglobulemic neuropathy. Neurology 1982;32:725-729.
  10. Alpa M, Ferrero B, Cavallo R et al. Anti-neuronal antibodies in patients with HCV-related mixed cryoglobulinemia. Autoimmunity Reviews 2008;8:56-58.
  11. Sacconi S, Salviati L, Merelli E. Acute disseminated encephalomyelitis associated with hepatitis C virus infection. Arch Neurol 2001;58:1679-1681.
  12. Bolay H, Sylemezolu 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;98:305-8.
  13. Radkowski M, Wilkinson J, Nowicki M et al. Search for hepatitis C virus negative-strand RNA sequences and analysis of viral sequences in the central nervous system: Evidence of replication. J Virol 2002;76:600-608.
  14. Laskus T, Radkowski M, Bednarska A et al. Detection and analysis of hepatitis C virus sequences in cerebrospinal fluid. J Virol 2002;76:10064-10068.
  15. Meriggioli MN, Rowin J. Chronic inflammatory demyelinating polyneuropathy after treatment with interferon-alpha. Muscle Nerve 2000;23:433-435.
  16. Marzo M, Tintore M, Fabregues O, Montalban X, Codina A. Chronic inflammatory demyelinating polyneuropathy during treatment with interferon-alpha. J Neurol Neurosurg Psychiatry 1998;65:604-615.
  17. Höftberger R, Garzuly F, Dienes HP et al. Fulminant central nervous system demyelination associated with interferon-alpha therapy and hepatitis C virus infection. Multiple Sclerosis 2007;13:1100-1106.