Refractory Mononeuritis Multiplex Due to Hepatitis C Infection and Cryoglobulinemia: Efficient Response to Rituximab.
BACKGROUND
Mononeuritis multiplex due to hepatitis C infection and cryoglobulinemia has no specific treatment guidelines. Despite the favorable evolution of the liver disease after treatment with interferon and ribavirin, neurological symptoms might not respond very efficiently to antiviral therapy.


METHODS
We report the case of a 50-year-old woman, with a mononeuritis multiplex related to cryoglobulinemia and hepatitis C virus infection, who was treated with rituximab. Hepatitis C virus infection was treated successfully with interferon-α and ribavirin, but the neurological symptoms were still worsening until rituximab therapy. Significant improvement of paraparesis and painful hypoesthesia were evident after the fourth infusion of rituximab. However, every 6 months, the neurological symptoms relapsed and the patient was subjected to a new cycle of rituximab therapy, with the disappearing of the paraparesis and hypoesthesias.


CONCLUSIONS
This case highlights the potential use of rituximab in immune-mediated neuropathies, especially the mononeuritis multiplex associated with hepatitis C infection.
Federal Hospital of State Servers, Neurology Service, Rio de Janeiro, Brazil.
Cristiane N
CN
Soares
D003449:Cryoglobulinemia / Q000150:complications*; D005260:Female; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000494:pharmacology*; D008875:Middle Aged; D020422:Mononeuropathies / Q000188:drug therapy* / Q000209:etiology; D000069283:Rituximab / Q000008:administration & dosage / Q000494:pharmacology*
D007155:Immunologic Factors; D000069283:Rituximab