[A 56-year-old female patient with Raynaud's syndrome, increased liver enzymes and neuropsychiatric symptoms].
METHODS
A 56-year-old woman presented with increased liver enzymes (GPT, GOT), arthralgias, Raynaud's syndrome and disturbance of sleep and concentration.


RESULTS
Serology and liver biopsy indicated chronic hepatitis C infection (HCV) and viral-induced liver cirrhosis with unremarkable liver synthesizing parameters. An HCV-triggered cryoglobinemia was excluded, but high elevated antinuclear antibodies (ANA) and anti-RNP autoantibodies, typical serological parameters of mixed tissue collagenous (Sharp}s disease), were detectable. Magnetic resonance spectroscopy (H-MRS) was performed to differentiate between cerebral vasculitis and mild hepatic encephalopathy. This detected abnormal pattern of cerebral metabolites (myo-inositol and choline), is specific for HE.


METHODS
After onset of an antiviral therapy (terferon/ribavirin), low protein diet with supplementation of l-ornithine-l-aspartate the arthralgia and neuropsychiatric symptoms rapidly improved and HCV-RNA PCR became negative. Unfortunately, after cessation of antiviral treatment the patient had a relapse of HCV with a worsening of the arthralgia and the Raynaud symptoms (HCV-triggered Sharp}s disease).


CONCLUSIONS
Even in patients with mildly abnormal liver function and liver cirrhosis it is important to consider (mild) hepatic encephalopathy if neuropsychiatric symptoms occur.
Hass
H G
HG
Abteilung Innere Medizin 3, Marienhospital, Stuttgart.
Kaiser
S
S
D000410:Alanine Transaminase / Q000097:blood; D000974:Antibodies, Antinuclear / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D018771:Arthralgia / Q000209:etiology; D001219:Aspartate Aminotransferases / Q000097:blood; D001288:Attention; D001323:Autoantibodies / Q000097:blood; D001324:Autoantigens / Q000276:immunology; D001921:Brain / Q000378:metabolism / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D006501:Hepatic Encephalopathy / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D018937:Hepatitis C Antibodies / Q000097:blood; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008099:Liver / Q000201:enzymology* / Q000473:pathology / Q000821:virology; D008103:Liver Cirrhosis / Q000473:pathology / Q000821:virology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D008947:Mixed Connective Tissue Disease / Q000175:diagnosis / Q000209:etiology; D012367:RNA, Viral / Q000097:blood; D011928:Raynaud Disease / Q000209:etiology*; D012893:Sleep Wake Disorders / Q000209:etiology; D055517:snRNP Core Proteins
D000974:Antibodies, Antinuclear; D000998:Antiviral Agents; D001323:Autoantibodies; D001324:Autoantigens; D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D055517:snRNP Core Proteins; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase