Peginterferon α-2a/ribavirin

Reactions 1280 - 28 Nov 2009 S Peginterferon α-2a/ribavirin Acute inflammatory demyelinating polyneuropathy (Guillain-Barre syndrome): case report A 55-year old man developed acute inflammatory demyelinating polyneuropathy (AIDP) from Guillain-Barre syndrome, while receiving peginterferon α-2a and ribavirin for hepatitis C infection. The man was commenced on peginterferon α-2a 180 µg/ ml weekly and ribavirin 1000 mg daily in divided doses. In week 8 of treatment, he presented with difficulty eating, loss of taste, and facial numbness and asymmetry. He was diagnosed with Bell palsy, and started on oral steroids. Peginterferon α-2a was withheld. The following week, there was a gradual onset of progressive weakness of his legs, and facial diplegia. He also started having back pain and neuropathic leg pain. His symptoms progressed over 2 weeks, until he became wheelchair-bound. Examination revealed decreased deep tendon reflexes in his arms, absent knee reflexes and decreased ankle reflexes. He had 4/5 motor strength in both legs and bilateral weakness in both upper and lower facial muscles. Electromyographic examination revealed increased latency, and decreased amplitude and velocity, in all nerves tested. A lumbar puncture revealed markedly elevated CSF protein levels. He was therefore diagnosed with acute inflammatory demyelinating polyneuropathy (Guillain-Barre-syndrome). The man was started on immunoglobulin. He was then transferred out for rehabilitation, and started improving. At last follow-up, he could walk short distances with a walker, and his neuropathic pain had significantly improved. Author comment: "We think it is important for clinicians to keep this association in mind when prescribing Peginterferon alfa-2a and [r]ibavirin for HCV treatment." Inglis B, et al. A Case of Guillain-Barre Syndrome (GBS) Associated with Peginterferon Alfa-2a and Weight Based Ribavirin for Chronic Hepatitis C (HCV). 74th Annual Scientific Meeting of the American College of Gastroenterology : abstr. P211, 23 Oct 2009. Available from: URL: http://www.acg.gi.org/ acgmeetings [abstract] - USA 803002451 1 Reactions 28 Nov 2009 No. 1280 0114-9954/10/1280-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved

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Transcript of Peginterferon α-2a/ribavirin

Reactions 1280 - 28 Nov 2009

SPeginterferon α-2a/ribavirin

Acute inflammatory demyelinatingpolyneuropathy (Guillain-Barre syndrome): casereport

A 55-year old man developed acute inflammatorydemyelinating polyneuropathy (AIDP) from Guillain-Barresyndrome, while receiving peginterferon α-2a and ribavirinfor hepatitis C infection.

The man was commenced on peginterferon α-2a 180 µg/ml weekly and ribavirin 1000 mg daily in divided doses. Inweek 8 of treatment, he presented with difficulty eating,loss of taste, and facial numbness and asymmetry. He wasdiagnosed with Bell palsy, and started on oral steroids.Peginterferon α-2a was withheld. The following week,there was a gradual onset of progressive weakness of hislegs, and facial diplegia. He also started having back painand neuropathic leg pain. His symptoms progressed over2 weeks, until he became wheelchair-bound. Examinationrevealed decreased deep tendon reflexes in his arms,absent knee reflexes and decreased ankle reflexes. He had4/5 motor strength in both legs and bilateral weakness inboth upper and lower facial muscles. Electromyographicexamination revealed increased latency, and decreasedamplitude and velocity, in all nerves tested. A lumbarpuncture revealed markedly elevated CSF protein levels.He was therefore diagnosed with acute inflammatorydemyelinating polyneuropathy (Guillain-Barre-syndrome).

The man was started on immunoglobulin. He was thentransferred out for rehabilitation, and started improving. Atlast follow-up, he could walk short distances with a walker,and his neuropathic pain had significantly improved.

Author comment: "We think it is important for cliniciansto keep this association in mind when prescribingPeginterferon alfa-2a and [r]ibavirin for HCV treatment."Inglis B, et al. A Case of Guillain-Barre Syndrome (GBS) Associated withPeginterferon Alfa-2a and Weight Based Ribavirin for Chronic Hepatitis C (HCV).74th Annual Scientific Meeting of the American College of Gastroenterology :abstr. P211, 23 Oct 2009. Available from: URL: http://www.acg.gi.org/acgmeetings [abstract] - USA 803002451