title: Sicca syndrome and dementia in a patient with hepatitis C infection: a case report with unusual bifocal extrahepatic manifestations.
abstract: BACKGROUND
  Hepatitis C virus (HCV) infections are associated with extrahepatic manifestations in 40-75 % of cases. Sialitis and secondary Sjögren syndrome are well characterized complications of chronic HCV infections but the mechanisms (primary or secondary) leading to xerostomia are not understood. Similarly, brain lesions due to HCV can be primary or secondary but the pathology of primary HCV-related brain lesions is not well described.
  
  
  METHODS
  We report the postmortem case of a 60-year old patient initially presenting with sicca syndrome and dementia. HCV was identified in the brain but not in the salivary glands using transcription-mediated amplification (TMA). Focal sialitis was found in submandibular glands. Neuropathological examination revealed the presence of multiple dot-sized demyelination foci.
  
  
  CONCLUSIONS
  Sicca syndrome is a common concern in chronic HCV infections and may be due to secondary immune mechanisms (we could not isolate HCV in salivary gland tissues). TMA had never been applied to the detection of viruses in salivary glands and neural tissues and proves to be a promising technique. Neuropathological reports in HCV infections are rare and the lesions we report may be the first characterization of the direct effect of HCV on brain cells. More cases are needed to define the full spectrum of lesions potentially caused by the direct action of the HCV on salivary glands and neural tissues.
authors.affiliation: Service de Chirurgie Maxillofaciale et Stomatologie, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France ; UPMC Université Paris 06, 75005 Paris, France ; Laboratoire de Neuropathologie Raymond-Escourolle, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
authors.forename: R H
authors.initials: RH
authors.lastname: Khonsari
authors.affiliation: Service de Microbiologie, Hôpital Beaujon, Clichy, France.
authors.forename: S
authors.initials: S
authors.lastname: Maylin
authors.affiliation: Service de Chirurgie Maxillofaciale et Stomatologie, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France ; UPMC Université Paris 06, 75005 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Nicol
authors.affiliation: INSERM U-773, Centre de recherche biomédicale Bichat-Beaujon CRB3, Université Paris VII, Clichy, France.
authors.forename: M
authors.initials: M
authors.lastname: Martinot-Peignoux
authors.affiliation: Service de Neurologie, Hôpital Henri Mondor, Créteil, France.
authors.forename: A
authors.initials: A
authors.lastname: Créange
authors.affiliation: UPMC Université Paris 06, 75005 Paris, France ; Laboratoire de Neuropathologie Raymond-Escourolle, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Duyckaerts
authors.affiliation: Service de Chirurgie Maxillofaciale et Stomatologie, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France ; UPMC Université Paris 06, 75005 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Bertolus
keywords: Encephalitis; Hepatitis C; Oligodendrocyte; Sicca syndrome; Sjögren syndrome; Transcription-mediated amplification
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