Reactions 1014 - 14 Aug 2004

SPeginterferon-α-2b/ribavirin

Liver decompensation: case reportA 36-year-old female liver transplant recipient developed

liver decompensation during peginterferon-α/ribavirin therapyfor recurrent hepatitis C virus infection.

Six months post-transplantation, the woman startedtreatment with peginterferon-α-2b 96 µg/week and ribavirin800 mg/day; her concomitant medication included tacrolimus.One month later, she developed massive ascites, jaundice andrenal failure.

Peginterferon-α-2b and ribavirin were discontinued.Laboratory investigations revealed ALT and AST levels of 42and 58 IU/L, respectively, a direct bilirubin level of 2.9 mg/dL, aprothrombin time of 18.6 seconds, an INR of 1.8, an albuminlevel of 2.4 g/dL, a creatinine level of 6.1 mg/dL and a urinesodium level of < 5 mmol/L. An ultrasound revealed asciteswith patent portal vein and hepatic vessels, and she had aserum albumin-ascites albumin gradient of > 1.1. After2 months of aggressive medical management, her ascitesresolved completely and her prothrombin time, bilirubin,albumin and creatinine levels normalised, although hertransaminase levels remained elevated.

Author comment: "The temporal association between theinitiation of combination therapy and the development ofdecompensated liver disease, together with its resolution afterdrug discontinuation, are strongly suggestive of a causalrelationship."Mukherjee S. Reversible decompensated liver disease as a possible complication ofpegylated - interferon alfa 2b and ribavirin for recurrent hepatitis C. Journal ofGastroenterology and Hepatology 19: 723-724, No. 6, Jun 2004 -USA 800982605

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Reactions 14 Aug 2004 No. 10140114-9954/10/1014-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved