title: Tumefactive multiple sclerosis and hepatitis C virus 2a/2C infection: Dual benefit of long-term interferon beta-1a therapy?
abstract: Hepatitis C virus (HCV) infection has been implicated in triggering acute disseminated encephalomyelitis but not tumefactive multiple sclerosis. We report the case of a 17-year-old female who presented with a 5-day history of left hemiparesis and hemisensory loss followed by a right third nerve palsy. Tumefactive multiple sclerosis was diagnosed based on the absence of encephalopathic signs, the presence of tumefactive brain lesions, the exclusion of neoplastic and infectious causes of the lesions by biopsy, and the occurrence of relapse after a period of remission. The patient was at risk for HCV infection due to parenteral drug abuse and multiple sexual partners. Serial HCV antibody tests and RNA polymerase chain reaction assays revealed acute HCV infection and genotyping showed HCV genotype 2a/2c. She was treated with high-dose methylprednisolone and discharged with only mild left hand weakness. Interferon beta-1a 30mcg was administered intramuscularly once a week. Remission from HCV infection was achieved in three years without standard anti-HCV therapy. This case suggests that CNS myelin is a potential target of the immune response to HCV 2a/2c infection, the HCV 2a/2c virus may be involved in triggering autoimmune tumefactive brain lesions, and interferon beta-1a is effective against HCV 2a/2c infection. We recommend serial HCV antibody testing and HCV RNA PCR assay, preferably with HCV genotyping, in all patients with acute inflammatory demyelinating diseases of the CNS.
authors.affiliation: Louisiana State University Health Sciences Center, Department of Neurology, 1542 Tulane Avenue, New Orleans, LA 70112, USA. Electronic address: emader@lsuhsc.edu.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Mader
authors.affiliation: Louisiana State University Health Sciences Center, Department of Neurology, 1542 Tulane Avenue, New Orleans, LA 70112, USA. Electronic address: wriche@lsuhsc.edu.
authors.forename: Wael
authors.initials: W
authors.lastname: Richeh
authors.affiliation: Louisiana State University Health Sciences Center, Department of Neurology, 1542 Tulane Avenue, New Orleans, LA 70112, USA. Electronic address: jmaury@lsuhsc.edu.
authors.forename: Joaquin Maury
authors.initials: JM
authors.lastname: Ochoa
authors.affiliation: Tulane University Health Sciences, Department of Pathology and Laboratory Medicine, 1430 Tulane Avenue SL-79, New Orleans, LA 70112, USA. Electronic address: lsulliva@tulane.edu.
authors.forename: Lacey L
authors.initials: LL
authors.lastname: Sullivan
authors.affiliation: Louisiana State University Health Sciences Center, Department of Neurology, 1542 Tulane Avenue, New Orleans, LA 70112, USA. Electronic address: agutie@lsuhsc.edu.
authors.forename: Amparo N
authors.initials: AN
authors.lastname: Gutierrez
authors.affiliation: Louisiana State University Health Sciences Center, Department of Neurology, 1542 Tulane Avenue, New Orleans, LA 70112, USA. Electronic address: jlover@lsuhsc.edu.
authors.forename: Jesus F
authors.initials: JF
authors.lastname: Lovera
mesh_terms: D000293:Adolescent; D003937:Diagnosis, Differential; D004673:Encephalomyelitis, Acute Disseminated / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology / Q000821:virology*; D005260:Female; D016174:Hepacivirus / Q000472:pathogenicity*; D006801:Humans; D000068556:Interferon beta-1a; D016899:Interferon-beta / Q000627:therapeutic use*; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D010291:Paresis / Q000188:drug therapy* / Q000209:etiology / Q000821:virology; D016896:Treatment Outcome
chemical_list: D016899:Interferon-beta; D000068556:Interferon beta-1a
keywords: Acute disseminated encephalomyelitis; HCV genotype 2a/2c; Hepatitis C virus infection; Interferon beta-1a; Peginterferon; Tumefactive multiple sclerosis