Hepatitis C Virus–Related Hepatic Myelopathy After Treatment With Sofosbuvir and Ribavirin: A Case Report
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Abstract
Letters7 March 2017Hepatitis C Virus–Related Hepatic Myelopathy After Treatment With Sofosbuvir and Ribavirin: A Case ReportLazzaro di Biase, MD, Marina Picillo, MD, Maria Eliza Freitas, MD, Esther Bui, MD, and Alfonso Fasano, MD, PhDLazzaro di Biase, MDFrom Campus Bio-Medico University of Rome, Rome, Italy; University of Salerno, Salerno, Italy; and Toronto Western Hospital and University Health Network, and University of Toronto, Toronto, Ontario, Canada.Search for more papers by this author, Marina Picillo, MDFrom Campus Bio-Medico University of Rome, Rome, Italy; University of Salerno, Salerno, Italy; and Toronto Western Hospital and University Health Network, and University of Toronto, Toronto, Ontario, Canada.Search for more papers by this author, Maria Eliza Freitas, MDFrom Campus Bio-Medico University of Rome, Rome, Italy; University of Salerno, Salerno, Italy; and Toronto Western Hospital and University Health Network, and University of Toronto, Toronto, Ontario, Canada.Search for more papers by this author, Esther Bui, MDFrom Campus Bio-Medico University of Rome, Rome, Italy; University of Salerno, Salerno, Italy; and Toronto Western Hospital and University Health Network, and University of Toronto, Toronto, Ontario, Canada.Search for more papers by this author, and Alfonso Fasano, MD, PhDFrom Campus Bio-Medico University of Rome, Rome, Italy; University of Salerno, Salerno, Italy; and Toronto Western Hospital and University Health Network, and University of Toronto, Toronto, Ontario, Canada.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L16-0038 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Hepatic myelopathy is a rare complication of advanced-phase liver dysfunction (1). The most common presentation is spastic paraparesis, which is associated with variable sensory deficits (2). Hepatic myelopathy is a progressive, disabling condition that may reverse if normal liver function is restored—for example, after transplantation (Appendix Table) (2). Sofosbuvir is a novel nucleotide analogue that inhibits the NS5B polymerase of hepatitis C virus (HCV). Sofosbuvir produces a high rate of sustained virologic response when used to treat HCV infection (3).Appendix Table. Outcome of Reported Patients With Hepatic Myelopathy Objective: ...References1. Liversedge LA, Rawson MD. Myelopathy in hepatic disease and portosystemic venous anastomosis. Lancet. 1966;1:277-9. [PMID: 4158891] CrossrefMedlineGoogle Scholar2. Caldwell C, Werdiger N, Jakab S, Schilsky M, Arvelakis A, Kulkarni S, et al. Use of model for end-stage liver disease exception points for early liver transplantation and successful reversal of hepatic myelopathy with a review of the literature. Liver Transpl. 2010;16:818-26. [PMID: 20583082] doi:10.1002/lt.22077 CrossrefMedlineGoogle Scholar3. Zeuzem S, Dusheiko GM, Salupere R, Mangia A, Flisiak R, Hyland RH, et al; VALENCE Investigators. Sofosbuvir and ribavirin in HCV genotypes 2 and 3. N Engl J Med. 2014;370:1993-2001. [PMID: 24795201] doi:10.1056/NEJMoa1316145 CrossrefMedlineGoogle Scholar4. Conn HO, Rössle M, Levy L, Glocker FX. Portosystemic myelopathy: spastic paraparesis after portosystemic shunting. Scand J Gastroenterol. 2006;41:619-25. [PMID: 16638707] CrossrefMedlineGoogle Scholar5. Scobie BA, Summerskill WH. Permanent paraplegia with cirrhosis. Arch Intern Med. 1964;113:805-10. [PMID: 14131967] CrossrefMedlineGoogle Scholar6. Bechar M, Freud M, Kott E, Kott I, Kravvic H, Stern J, et al. Hepatic cirrhosis with post-shunt myelopathy. J Neurol Sci. 1970;11:101-7. [PMID: 5456541] CrossrefMedlineGoogle Scholar7. Robinson CE, Anzarut A. Myelopathy in cirrhosis. Paraplegia. 1978;16:3-4. [PMID: 733284] MedlineGoogle Scholar8. Giangaspero F, Dondi C, Scarani P, Zanetti G, Marchesini G. Degeneration of the corticospinal tract following portosystemic shunt associated with spinal cord infarction. Virchows Arch A Pathol Anat Histopathol. 1985;406:475-81. [PMID: 3925620] CrossrefMedlineGoogle Scholar9. Lebovics E, DeMatteo RE, Schaffner F, Gendelman S. Portal-systemic myelopathy after portacaval shunt surgery. Arch Intern Med. 1985;145:1921-2. [PMID: 4037954] CrossrefMedlineGoogle Scholar10. Mendoza G, Marti-Fàbregas J, Kulisevsky J, Escartín A. Hepatic myelopathy: a rare complication of portacaval shunt. Eur Neurol. 1994;34:209-12. [PMID: 8082679] CrossrefMedlineGoogle Scholar11. Sobukawa E, Sakimura K, Hoshino S, Hoshino M, Miyoshi K. Hepatic myelopathy: an unusual neurological complication of advanced hepatic disease. Intern Med. 1994;33:718-22. [PMID: 7849390] CrossrefMedlineGoogle Scholar12. Counsell C, Warlow C. Failure of presumed hepatic myelopathy to improve after liver transplantation [Letter]. J Neurol Neurosurg Psychiatry. 1996;60:590. [PMID: 8778275] CrossrefMedlineGoogle Scholar13. Troisi R, Debruyne J, de Hemptinne B. Improvement of hepatic myelopathy after liver transplantation [Letter]. N Engl J Med. 1999;340:151. [PMID: 9917218] CrossrefMedlineGoogle Scholar14. Weissenborn K, Tietge UJ, Bokemeyer M, Mohammadi B, Bode U, Manns MP, et al. Liver transplantation improves hepatic myelopathy: evidence by three cases. Gastroenterology. 2003;124:346-51. [PMID: 12557140] CrossrefMedlineGoogle Scholar15. Nardone R, Buratti T, Oliviero A, Lochmann A, Tezzon F. Corticospinal involvement in patients with a portosystemic shunt due to liver cirrhosis: a MEP study. J Neurol. 2006;253:81-5. [PMID: 16047111] CrossrefMedlineGoogle Scholar16. Koo JE, Lim YS, Myung SJ, Suh KS, Kim KM, Lee HC, et al. Hepatic myelopathy as a presenting neurological complication in patients with cirrhosis and spontaneous splenorenal shunt. Korean J Hepatol. 2008;14:89-96. [PMID: 18367861] doi:10.3350/kjhep.2008.14.1.89 CrossrefMedlineGoogle Scholar17. Qu B, Liu C, Guo L, Yang Y, Li JH, Yu L, et al. The role of liver transplantation in the treatment of hepatic myelopathy: case report with review of the literature. Transplant Proc. 2009;41:1987-9. [PMID: 19545775] doi:10.1016/j.transproceed.2009.01.105 CrossrefMedlineGoogle Scholar18. Pinarbasi B, Kaymakoglu S, Matur Z, Akyuz F, Demir K, Besisik F, et al. Are acquired hepatocerebral degeneration and hepatic myelopathy reversible? J Clin Gastroenterol. 2009;43:176-81. [PMID: 18698265] doi:10.1097/MCG.0b013e318150d399 CrossrefMedlineGoogle Scholar19. Baccarani U, Zola E, Adani GL, Cavalletti M, Schiff S, Cagnin A, et al. Reversal of hepatic myelopathy after liver transplantation: fifteen plus one [Letter]. Liver Transpl. 2010;16:1336-7. [PMID: 21031552] doi:10.1002/lt.22149 CrossrefMedlineGoogle Scholar20. Premkumar M, Bagchi A, Kapoor N, Gupta A, Maurya G, Vatsya S, et al. Hepatic myelopathy in a patient with decompensated alcoholic cirrhosis and portal colopathy. Case Reports Hepatol. 2012;2012:735906. [PMID: 25374709] doi:10.1155/2012/735906 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Campus Bio-Medico University of Rome, Rome, Italy; University of Salerno, Salerno, Italy; and Toronto Western Hospital and University Health Network, and University of Toronto, Toronto, Ontario, Canada.Grant Support: Dr. Freitas is supported by the Paul and Susan Hansen Clinical Fellowship Award. Dr. Fasano is supported by grants from the University of Toronto, McLaughlin Centre, and Michael J. Fox Foundation.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L16-0038. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySpontaneous remission of hepatic myelopathy in a patient with alcoholic cirrhosis: A case reportLiver Transplantation Reverses Hepatic Myelopathy in Hepatitis B-Related Decompensated Liver Cirrhosis: Case Report and Review of the LiteratureMetabolic and Toxic MyelopathiesThe effect of fecal microbiota transplantation on Hepatic myelopathyMotor Cortex Mapping in Patients With Hepatic Myelopathy After Transjugular Intrahepatic Portosystemic Shunt 7 March 2017Volume 166, Issue 5Page: 379-380KeywordsBrain diseasesDisclosureHematologic testsLiver transplantationMyelopathyProteinsSpineTransplantationViral loadWheelchairs ePublished: 7 March 2017 Issue Published: 7 March 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.004 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.008 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".