Reactions 1094 - 25 Mar 2006

★Peginterferon-α-2a/ribavirin

First report of tuberculosis reactivation: case reportA reactivation of tuberculosis (TB) developed in a 62-year-

old man during peginterferon-α-2a and ribavirin treatment forchronic hepatitis C virus infection.1,2

The man, who had a history of a fibrous-calcific infiltrate inhis upper right lobe on chest x-ray 11 years previously, startedreceiving SC peginterferon-α-2a2180 µg/week and oralribavirin 1000 mg/day.1 Seven months later, he suddenlydeveloped cough and haemoptysis, and a lung lesion, whichwas highly indicative of TB, was revealed at the samepulmonary site where the infiltrate had been previouslydetected. A CT scan revealed two infiltrates, which werecomplicated by excavation. Sputum analysis andbronchoalveolar lavage were positive for Mycobacteriumtuberculosis, which was susceptible to all tested antibacterialagents; a Mantoux skin test was also positive. Laboratoryinvestigations showed absolute lymphopenia, and a T-cellsubset analysis showed severe underlyingimmunosuppression (CD4+ rate < CD8+ rate); prior topeginterferon-α-2a and ribavirin treatment, progressiveleucopenia had been observed.

The man received rifampicin, isoniazid, pyrazinamide andethambutol treatment but, after 5 weeks, his sputum remainedpositive for acid-fast bacilli.1 After 10 weeks’ of antituberculartherapy, lymphopenia slowly ameliorated and hisCD4+:CD8+ ratio approached 1. He received 3 weeks’adjunctive streptomycin therapy and, after a total of 13 weeksof anti-infective therapy, his TB resolved. Peginterferon-α-2aand ribavirin treatment was continued for 12 months overall.1. Sabbatani S, et al. Reactivation of severe, acute pulmonary tuberculosis during

treatment with pegylated interferon-alpha and ribavirin for chronic HCVhepatitis. Scandinavian Journal of Infectious Diseases 38: 205-208, No. 3, Mar2006.

2. Manfredi R. Re: case report of TB Personal Communications : [1 page], 10 Mar2006.

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» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of tuberculosis associatedwith peginterferon-α-2a or ribavirin. The WHO Adverse DrugReactions database contained three reports of infection TBCassociated with peginterferon-α-2a and 13 with ribavirin.

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Reactions 25 Mar 2006 No. 10940114-9954/10/1094-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved