Peginterferon-α-2a
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Reactions 1412 - 28 Jul 2012 S Peginterferon-α-2a De novo cryoglobulinaemic mononeuritis multiplex?: case report A 47-year-old man developed severe de novo cryoglobulinaemic mononeuritis multiplex (MNM) after 30 weeks of treatment with peginterferon-α-2a [Pegasys] for chronic hepatitis C virus (HCV) infection. The man had advanced hepatic fibrosis and had started antiviral treatment with peginterferon-α-2a 180µg weekly [route not stated] and ribavirin. During week 30 of antiviral treatment, he presented to hospital with a 2-week history of progressive painful bilateral foot drop, left ankle monoarthritis and weakness, and sensory loss in the distribution of the left ulnar nerve. A week later his right ulnar nerve became also involved. Neurophysiology studies suggested an assymmetrical mixed sensory and motor peripheral neuropathy, and a diagnosis of MNM was made. Cryoglobulin levels (type II) were elevated, ANA was positive, and C4 complement levels were low. Peginterferon-α-2a and ribavirin were discontinued immediately, and the man received prednisolone. His condition worsened over the following weeks with the development of progressive bilateral median and common peroneal nerve palsies and cutaneous vasculitic signs. He underwent plasma exchange. His neuropathic pain improved, and neurological function stabilised. Over the 4 following months, his condition improved further, with resolution of his joint pain and peroneal nerve palsies, and he was able to ambulate with walking sticks. Three months after the onset of MNM, he developed depression and died following a drug overdose 10 months after MNM onset. Author comment: "In our case the temporal association (both in terms of onset and recovery) between neurological symptoms, cryoglobulinaemia and the use of antiviral treatment raises the intriguing possibility that MNM could have been induced by antiviral therapy. However, it must be emphasised that at present this presumed association between [peginterferon-α-2a] and MNM remains speculative." Potts JR, et al. De novo cryoglobulinaemic mononeuritis multiplex during treatment of chronic hepatitis C infection: A viral effect or induced by pegylated interferon alpha?. Case Reports in Gastroenterology 6: 155-161, No. 1, Jan-Apr 2012. Available from: URL: http://dx.doi.org/10.1159/000337871 - United Kingdom 803074107 1 Reactions 28 Jul 2012 No. 1412 0114-9954/10/1412-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Peginterferon-α-2a
Reactions 1412 - 28 Jul 2012
SPeginterferon-α-2a
De novo cryoglobulinaemic mononeuritismultiplex?: case report
A 47-year-old man developed severe de novocryoglobulinaemic mononeuritis multiplex (MNM) after30 weeks of treatment with peginterferon-α-2a [Pegasys]for chronic hepatitis C virus (HCV) infection.
The man had advanced hepatic fibrosis and had startedantiviral treatment with peginterferon-α-2a 180µg weekly[route not stated] and ribavirin. During week 30 of antiviraltreatment, he presented to hospital with a 2-week historyof progressive painful bilateral foot drop, left anklemonoarthritis and weakness, and sensory loss in thedistribution of the left ulnar nerve. A week later his rightulnar nerve became also involved. Neurophysiologystudies suggested an assymmetrical mixed sensory andmotor peripheral neuropathy, and a diagnosis of MNM wasmade. Cryoglobulin levels (type II) were elevated, ANA waspositive, and C4 complement levels were low.
Peginterferon-α-2a and ribavirin were discontinuedimmediately, and the man received prednisolone. Hiscondition worsened over the following weeks with thedevelopment of progressive bilateral median and commonperoneal nerve palsies and cutaneous vasculitic signs. Heunderwent plasma exchange. His neuropathic painimproved, and neurological function stabilised. Over the4 following months, his condition improved further, withresolution of his joint pain and peroneal nerve palsies, andhe was able to ambulate with walking sticks. Three monthsafter the onset of MNM, he developed depression and diedfollowing a drug overdose 10 months after MNM onset.
Author comment: "In our case the temporal association(both in terms of onset and recovery) between neurologicalsymptoms, cryoglobulinaemia and the use of antiviraltreatment raises the intriguing possibility that MNM couldhave been induced by antiviral therapy. However, it must beemphasised that at present this presumed associationbetween [peginterferon-α-2a] and MNM remains speculative."Potts JR, et al. De novo cryoglobulinaemic mononeuritis multiplex duringtreatment of chronic hepatitis C infection: A viral effect or induced by pegylatedinterferon alpha?. Case Reports in Gastroenterology 6: 155-161, No. 1, Jan-Apr2012. Available from: URL: http://dx.doi.org/10.1159/000337871 - UnitedKingdom 803074107
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Reactions 28 Jul 2012 No. 14120114-9954/10/1412-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
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