[First clinical manifestation of chronic hepatitis C in painless progressive atrophic monoparesis of the right leg].

HISTORY AND CLINICAL FINDINGS: A 60-year-old male patient was admitted with a painless reduction in the circumference of the right calf with mild gait disturbance that had been increasing for 6 months. Neurological findings included atrophic monoparesis of the right lower leg with preserved muscle reflexes without sensory disturbances.

INVESTIGATIONS: Electrophysiologically and neuroradiologically, only the right triceps surae muscle showed signs of combined acute and chronic damage and marked atrophy with diffuse muscle oedema. With elevated liver enzymes, previously unknown positive hepatitis C serology and high hepatitis C viral load in serum, even pleocytosis with very low viral load was detectable in the CSF.

DIAGNOSIS: A diagnosis of hepatitis C-associated mononeuropathy of the right sciatic nerve with focal involvement of the right tibial nerve was made.

THERAPY AND COURSE: After therapy with Sofosbuvir and Velpatasvir, no further progression of the monoparesis occurred during the further course.

CONCLUSIONS

Chronic hepatitis C may be rarely associated with painless progressive monoparesis. With regard to pathogenesis, the significance of CSF requires further studies.