Hepatitis C virus-mediated neuromyelitis optica: An exceptional association. Case report
DOI:
https://doi.org/10.59093/27112330.150Keywords:
neuromyelitis optica, hepatitis C, chronic, autoimmune diseases, aquaporin 4, mielitis.Abstract
Neuromyelitis optica (NMO) is an autoimmune demyelinating disorder of the central nervous system characterized by antibodies directed against aquaporin-4 (AQP4). Its association with chronic hepatitis C is rare but clinically relevant. We present a patient with chronic hepatitis C who developed extensive longitudinal myelitis and optic neuritis, consistent with NMO. The patient was seropositive for anti-AQP4 antibodies and had subacute neurological manifestations. Other infectious and neoplastic causes were ruled out. She was treated with corticosteroids and subsequently with azathioprine, with a favorable clinical response. Pathophysiological mechanisms linking hepatitis C virus (HCV) infection with the genesis of NMO are explored, including polyclonal B-cell activation, cryoglobulinemic vasculitis, disruption of the blood-brain barrier, and cross-immunopathology. This case reinforces the need to consider NMO as a differential diagnosis in patients with HCV and subacute neurological symptoms, especially when anti-AQP4 antibodies are identified. The pathogenic relationship between the two conditions, although rare, should be taken into account for early diagnosis and the timely initiation of immunomodulatory treatment.
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