Reactions 1218 - 6 Sep 2008

SPeginterferon-αGeneralised peripheral lymphadenopathy: casereport

A 62-year-old woman developed generalised peripherallymphadenopathy after receiving peginterferon-α for chronichepatitis C.

The woman had received peginterferon-α and ribavirin ontwo previous occasions. Subsequently, during a 48-weekcourse of peginterferon-α 180µg once weekly with ribavirin,she experienced fatigue, alopecia, dry eyes and aphthousmouth ulcers. Two weeks before the end of treatment, shenoticed progressive and painless enlargement of her leftsupraclavicular and axillary lymph nodes. Over the next8 weeks, the nodes grew to 25mm and 10mm, respectively,and she was hospitalised. Blood tests revealed normocyticnormochromic anaemia, leucopenia and a low platelet count.Her erythrocyte sedimentation rate was increased and she hadraised serum β2 microglobulin levels.

Abdominal ultrasound and CT scanning showed small, solid,nodular, hyperechogenic lesions in the liver, suggestinghaemangiomas; also a lymph node in the coeliac trunkmeasuring 15mm. An abdominal MRI revealed nodular hepaticlesions suggestive of granulomas. A CT scan of the thoraxdemonstrated enlarged lymph nodes in the left axilla.Histopathological investigation of the lymphadenopathy andhepatic nodules led to a diagnosis of peginterferon-α-inducedgranulomatous lymphadenitis, with sarcoid-type andtuberculoid-type granulomas.

The woman was treated with isoniazid, rifampicin,pyrazinamide, ethambutol and pyridoxine [vitamin B6]. After2 months’ antitubercular treatment, and 6 months aftercompletion of peginterferon-α treatment, her enlarged nodeshad completely regressed. Antitubercular treatment continuedfor another 7 months, and 2 years after its completion sheremained well.

Author comment: "The exact etiology of thegranulomatous peripheral generalized lymphadenopathycould not be determined".Ferreira CN, et al. Generalized peripheral lymphadenopathy in a patient treated forchronic HCV infection. Nature Clinical Practice Gastroenterology and Hepatology5: 469-474, No. 8, Aug 2008 - Portugal 801117677

1

Reactions 6 Sep 2008 No. 12180114-9954/10/1218-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved