HEPATITIS C infection remains a critical diagnostic consideration during the clinical evaluation of systemic vasculitic neuropathy. In a single-center cohort study of 66 adults evaluated for vasculitic neuropathy, hepatitis C was documented as an extraneural manifestation in 6.1% of individuals. Peripheral nerve involvement proved pervasive across the study population, with muscle weakness documented in 90.9% of cases, neuropathic pain in 93.9%, sensory loss in 69.7%, and foot drop in 31.8%. Secondary systemic vasculitides formed half of all cases, notably including cryoglobulinemic vasculitis in 10.6% of patients, with matching cryoglobulin positivity in 10.6% and depressed complement C4 levels in 6.1%.
To distinguish systemic secondary disorders from nonsystemic forms, clinicians implemented a comprehensive diagnostic workflow integrating hepatitis C serologies, cryoglobulin quantification, and electrodiagnostic evaluations. Histopathological confirmation was pursued through nerve, skin, or renal biopsies, which demonstrated active vascular inflammation in 85.4% of sampled cases. Among the four patients presenting with hepatitis C, two achieved meaningful functional recovery on the quantitative Neuropathy Impairment Score, while two patients failed to improve. Overall, 59.1% of cohort participants attained clinical improvement following immunomodulatory intervention, 7.6% remained stable, and 33.3% experienced neurological deterioration over a median follow-up of 13.5 months.
Therapeutic strategies primarily relied on corticosteroids combined with steroid-sparing immunosuppressants in 51.5% of patients, corticosteroid monotherapy in 28.8%, and intravenous immunoglobulin regimens in 12.1%. Neurological recovery strongly correlated with timely therapeutic action. Patients who achieved neurological improvement experienced a significantly shorter diagnostic delay of 12.3 months compared to 30.3 months among non-improvers. Furthermore, higher baseline motor impairment subscores independently predicted functional gains on multivariable regression analysis. These findings underline the necessity of rapid serologic screening for hepatitis C and immediate treatment initiation to preserve motor function and halt irreversible peripheral nerve ischemia.
Reference
Rakhmonova S et al. Vasculitic neuropathy: clinical features, diagnostic approach, and neurological outcomes in a single-center cohort. Front Neurol. 2026;17:1886100.
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