Acute wrist and foot drop associated with hepatitis C virus related mixed cryoglobulinemia: Rapid response to treatment with rituximab
Received 21 July 2009; received in revised form 29 September 2009; accepted 6 October 2009. published online 06 November 2009.
Abstract
The nature of the B-cell subsets associated with chronic hepatitis C virus related type II mixed cryoglobulinemia (HCV-MC) is unclear.
We report the case of a 64-year-male with acute onset wrist drop and foot drop, secondary to HCV-MC related mononeuritis multiplex, who was treated with rituximab, an anti-CD20+ antibody directed against B cells. We monitored the frequency of B-cell subsets in peripheral blood before and after rituximab, and correlated B-cell subset changes with clinical response.
Significant improvements in his wrist and foot drop, as well as his vasculitic rash, depression and erectile dysfunction were evident within six days of starting rituximab and have persisted several months after B-cell recovery.
More than 95% of CD20+ B cells had disappeared from peripheral blood within 1 week, returning to baseline by week 21. CD20+CXCR3+ frequency at baseline was similar to that at week 21. CD20+CD5+, the human equivalent of B1 B cells and CD20+IgM+IgD+, naïve B cells were increased. By contrast, CD20+CD27+ memory cell frequency was reduced.
These data suggest that CD27+ memory B cells, but not CD5+ and IgM+IgD+ B cells may play a role in the clinical manifestations of cryoglobulinemia.
aDepartment of Medicine, New York Downtown Hospital, NY, United States
bCenter for the Study of Hepatitis C, Weill Medical College of Cornell University and Rockefeller University, New York, NY, United States
Corresponding author. Present address: Liver Center, Suite 7A-055, Beth Israel Medical Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA 02115, United States. Tel.: +1 617 632 9838; fax: +1 617 632 9840.
ABSTRACT