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Extrahepatic Manifestations of Hepatitis C Virus Infection
- Tjaard U. Hoogenraad, MD;
- Gerard H. Jansen, MD; and
- Jan van Hattum, MD
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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.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
