Reactions 1503, p35 - 31 May 2014

SPeginterferon-α-2a/ribavirin

Debilitating fatigue and worsening jaundice: casereport

A 49-year-old man experienced debilitating fatigue andworsening of jaundice following treatment with peginterferon-α-2a and ribavirin for fibrosing cholestatic hepatitis after livertransplantation.

The man had developed abdominal discomfort andabnormal liver chemistry tests 6 months after livertransplantation (LT). Twelve months after LT, his liverchemistry tests remained abnormal with jaundice and fatigue.The tests then showed findings suggestive of cholestaticvariant of recurrent hepatitis C. He then received SC injectionof peginterferon-α-2a 90µg weekly and oral ribavirin 200mgtwice per day. The man developed debilitating fatigue andworsening jaundice [duration of treatment to reaction onsetnot stated]. Ribavirin and peginterferon-α-2a werediscontinued 2 weeks after onset of treatment.

The man was treated with sofosbuvir and ribavirin16 months after LT. He did not experience any new sideeffects. Two weeks after completion of this treatment his liverchemistry tests normalised and his condition improved.

Author comment: "After recurrence of his HCV, ourpatient had cholestasis and rapidly progressing fibrosis notedon his liver biopsies, consistent with FCH. An attempt attreatment with pegylated interferon and ribavirin was poorlytolerated."Kim B, et al. Case report of successful treatment of fibrosing cholestatic hepatitis cwith sofosbuvir and ribavirin after liver transplantation. Seminars in Liver Disease34: 108-112, No. 1, Feb 2014 - USA 803103995

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Reactions 31 May 2014 No. 15030114-9954/14/1503-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved