Introduction
There are several extrahepatic manifestations associated with liver disease. Arthralgia, skin manifestations, xerostomia, xerophthalmia, and sensory neuropathy were the most commonly presented symptoms in order of frequency. The mechanism of these symptoms has been explained as an autoimmune disorders.
It has been also reported that synovial cells, which are lining a joint cavity, were infiltrated by virus-like particles and resulted in arthritis. There are several reports about shoulder and knee arthropathy associated with chronic hepatitis.
However, lumbar synovial cyst is not a well-documented complication. Our reports suggest that lumbar synovial cyst (LSC) may occur to the patients with viral hepatitis as an extrahepatic manifestation.
Methods
The retrospective study included those who underwent spine MRI, laboratory test for chronic hepatitis (HbsAg, anti-HCV IgG) from 2010 to 2014.
Search terminology for lumbar synovial cyst included facet synovial cyst, lumbar synovial cyst, spinal synovial cyst, intraspinal synovial cyst or juxtafacet cyst on MRI formal reading. Those who had diagnosed as hepatocellular carcinoma, Liver cirrhosis, or who had history of pelvic or lumbar fracture, who had traumatic injury, and rheumatoid disease such as rheumatoid arthritis, ankylosing spondylitis are excluded.
To exclude age, sex related confounding, we used greedy matching to generate age-sex matched control between chronic hepatitis patient and non-chronic hepatitis patient.
Correlations of lumbar synovial cyst with viral hepatitis were assessed by chi-square test.
Results
After matching, total 2298 patients were included, Those with LCS were 9 (2.30%) in chronic hepatitis patient, and 30 (1.3%) overall. Chronic hepatitis is correlated with lumbar synovial cyst (P=0.048). (Table 1)
Conclusion
Chronic hepatitis is correlated with lumbar synovial cyst. Therefore, when chronic hepatitis patient complaints of back pain, lumbar synovial cyst must be suspected as it is curable disease. |
