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Título

FIRST REPORT OF HEPATITIS C PATIENT WITH NEUROMYELIT OPTIC SPECTRUM DISORDER ANTI-AQP4 ANTIBODIES (+) AND REMARKABLE HIGH LEVEL OF NEUROFILAMENT LIGHT CHAIN

RESUMO

Hepatitis-related viruses usually stimulate extra hepatic manifestations in most of the cases. An important representative of these viruses is the hepatitis C virus (HCV), which is also associated to chronic silent infections that can last several years before a diagnosis, leading to cirrhosis and hepatocellular carcinoma. Our aim here is to present a rare phenotype of extra hepatic manifestation involving nervous system, the neuromyelitis optical spectrum disorder (NMOSD), and the correlation with plasma biomarkers level of neurodegeneration. We identified a 68-years-old female patient who has been diagnosed for the hepatitis C in 2014, with a sustained high viral load along the years (~10 UI/mL). In 2021, she received the diagnosis of NMOSD, while presenting HCV detectable in serum and symptoms related to this viral infection. By the time, her blood sample was collected and evaluated for anti-MOG (Myelin-Oligodendrocyte Glycoprotein) and anti-AQP4 (AQuaPorin 4) antibodies detection by CBA (Cell-Based Assay), which showed positivity for anti-AQP4 antibodies. Neuroimaging showed extensive lesion involving of brainstem and extensive central spinal cord lesion from cervical to l dorsal level. During the onset of NMOSD, she was also presented urinary infection, hemorrhagic gastritis and high HCV viral load, followed by several hospitalization events, with active disease since then. For a better understanding of this case, we evaluated neurofilament light chain (NfL) levels using SIMOA (Single Molecule Array). The plasma NfL level in 2022 was 365.51 pg/mL (SD=48.39) that compared with matched age control group was very high (~11.73 pg/mL). This result corroborates the severity findings for patients in neuroinflammatory and neurodegenerative processes associated to viral trigger and can contribute to better understanding the large spectrum of NMOSD. The NfL levels can contribute as biomarker for neuroinflammatory and neurodegenerative disease, including those associated to viral trigger. Here, we show the first case of HCV patient positive for anti-AQP4 antibodies, reinforcing that there is a wide neuromyelitis spectrum disorders associated to AQP-4 antibody identified after different viral trigger, suggesting a probable relationship between viral infections and neurological manifestations.

Palavras Chave

Hepatitis C; NMOSD; AQP4