Acute myelitis associated with HCV infection

Abstract

We report a case of acute myelitis associated with hepatitis C virus (HCV) infection. A Japanese woman developed left calf pain and weakness, but this quickly generalised to paraplegia. We diagnosed acute myelitis based on the results of clinical manifestations, an MRI examination and a cerebrospinal fluid (CSF) examination. The clinical condition and spinal cord lesions improved following intravenous administration of methylprednisolone. The patient had been diagnosed with HCV infection 11 years before the onset. We detected HCV RNA in the CSF, supporting the strong association of our patient's myelitis. However, it is difficult to conclude whether the neurological condition was caused directly by the viral load or indirectly by the immune response. We suggest that testing for HCV infection is important in patients with myelitis. In particular, anti-HCV antibody and HCV RNA should be measured in the patients' serum as well as CSF.

Figure 1

Spinal cord MRI of the patient was obtained at the time of onset (A–D) and 1 year later (E, F). (A) There was a mild swelling of the spinal cord at the level of L2. The lesions are of iso-intensity on a T1-weighted image. (B) T2-weighted image of the spinal cord shows highly intense lesions at the levels of Th10 and Th12 to L2 of the vertebral bodies. (C, D) On axial T2-weighted images, the lesions can be seen to be located in the grey and white matter at the level of Th10 and Th12. (E, F) 1 year later, there was an improvement of the hyperintense lesions and swelling of the spinal cord on T1-weighted (E) and T2-weighted (F) images.