I Nagy

Early termination of pegylated interferon (PEG-IFN) plus ribavirin (RBV) therapy due to a pulmonary complication in a patient with chronic hepatitis C (CHC)

Background: Treatment with PEG-IFN is known to increase the risk of bacterial airway infections such as bronchitis, pneumonia and tuberculosis (TBC). We report here a case of pulmonary side-effects complicating PEG-IFN plus RBV therapy in a patient with CHC. Case report: From October 2006, a 46-year-old man with high viral load CHC was treated with PEG-IFN-alfa2b in combination with RBV. This thrombophylic patient was receiving permanent acenocoumarol therapy because of repetitive venous thromboses. By week 10, we observed transient black stools without any other clinical or laboratory signs of gastrointestinal bleeding. There was no need to change the dosage of his antiviral drugs. By week 12, his treatment had yielded a good early virological response. At week 29, he experienced fever. The chest X-ray ordered by the pulmonologist demonstrated bilateral nodular and bundled miliary lesions in the upper lobes, suggesting the possibility of fibrosis, microembolization or miliary TBC. The PEG-IFN plus RBV therapy was stopped at once. A chest CT scan revealed small miliary lesions suspicious of TBC. The Mantoux test was negative. The pulmonologists final opinion was pneumonia, because the clinical and radiological symptoms had disappeared after 6 weeks of observation. Six months after the termination of therapy, the patient was negative for HCV RNA. Conclusions: During PEG-IFN plus RBV therapy, signs of pulmonary complications should prompt careful clinical examinations and work-up, and in some cases it may be necessary to terminate the therapy. In the present case, the patients sustained virological response was fortunate as regards the high viral load and the early termination of therapy at week 29.