A Patient with HCV Infection and a Sustained Virological Response to Direct-acting Antiviral Treatment Who Developed Inclusion Body Myositis

Abstract

We report the case of a 75-year-old woman who was found to have hepatitis C virus (HCV) infection in 1987. Before treatment in 2016, she was found to have mixed cryoglobulinemia (MC). Direct-acting antiviral (DAA) treatment produced a sustained virological response 12 (SVR12). She noticed gradual muscle weakness in 2015 and the gradual development of dysarthria and dysphagia in 2017. We performed a muscle biopsy that showed inclusion body myositis (IBM). To the best of our knowledge, this is first case of a patient with HCV infection, MC, and IBM, in which MC and IBM did not improve after an SVR12 was obtained by DAA treatment.

Keywords: direct-acting antiviral; hepatitis C virus; inclusion body myositis; mixed cryoglobulinemia; sustained virological response.

Figure 1.

The clinical course of one case. The clinical course of a patient who obtained HCV eradication and an SVR12 through DAA therapy without an improvement of IBM and MC. CK: creatine kinase, HCV: hepatitis C virus, DAA: direct acting antiviral, IBM: inclusion body myositis, MC: mixed cryoglobulinemia, SVR12: sustained virological response 12, MMT: manual muscle testing

Figure 2.

The histological findings. A histopathological examination demonstrated CD8-positive inflammatory cell infiltration with non-necrotic muscular fibers. Rimmed vacuoles were present in some muscle fibers. The specimen was immunopositive for p62. Hematoxylin and Eosin staining (a), Gomori-Trichrome staining (b), immunohistochemical staining of anti-CD8 antibodies (c), immunohistochemical staining of anti-p62 antibodies (d).

Figure 3.

The imaging findings. Plain CT in 2017 revealed symmetric atrophy of both forearms (a). MRI revealed symmetrical heterogeneous areas of high signal intensity in both thighs on T2-STIR sequences (b).