Introduction: Hepatitis C virus (HCV) infection affects almost 180 million people around the world. Even though the development of direct acting antivirals (DAAs) has significantly improved the treatment responses to HCV infection, treatment with pegylated interferon (PegIFN) in combination with ribavirin is considered the standard of care (SOC) for chronic HCV infection treatment in countries with limited medical resources. Considering the inhibitory effect of vitamin B12 on HCV replication, we have evaluated the effect of vitamin B12 supplementation along with SOC on treatment outcomes in patients with chronic HCV infection, who were antiviral treatment-naive. Methods: In this regard, seventy-four HCV-infected patients, naïve to antiviral therapy, were randomly assigned to receive SOC or SOC in addition to vitamin B12 (SOC + B12). Viral response was evaluated at 4, 12, 24 and 48 weeks following the initiation of viral treatment and at 24 weeks after completing the treatment. Genotyping of the interleukin 28B (IL28B) polymorphisms was also performed. Demographic characteristics, clinical findings, fibroscan results and drug adverse effects were recorded. Results: Our findings showed that rapid viral response was not significantly different between the two groups; however, the rates of complete early viral response (cEVR) (p=0.033), end-of-treatment viral response (ETVR) (p=0.001) and sustained virologic response (SVR) (p=0.0001) were significantly higher in SOC + B12 patients compared to SOC patients. Besides, in SOC + B12 patients, those with a higher baseline viral load and carriers of IL28B CC genotype showed significantly higher rate of SVR. Conclusion: In conclusion, the addition of vitamin B12 significantly improved the rate of SVR in HCV-infected patients, who were naïve to antiviral therapy. As this treatment regimen is safe and inexpensive, it proposes an option for improving the effectiveness of the HCV treatment with SOC, particularly in resource-limited settings.

A 54-year-old man was referred to our center with complaint of dysphagia since 1 year ago. Before admission to our center, esophagogastroduodenoscopy (EGD) had been done by general internist, which was reported normal. The patient had mentioned discomfort with solid and liquid diets. He suffered from cough and sometimes nausea during swallowing. Nasal regurgitation was not reported. Because of such complaints, thorough gastrointestinal and pulmonary investigations were performed and eventually he was discharged with medical treatment.The patient's dysphagia exacerbated over the last month, so more investigations were done. No weight loss was detected. Drug history revealed consumption of amiodarone and captopril for longstanding hypertension. Medical history showed surgery of cervical vertebrae due to car accident and fixation of fracture by cervical plate 10 years earlier. After surgery, the patient had developed abscess formation, therefore another surgery for drainage of abscess collection had been done.Physical examination was otherwise normal, except the scar at the site of previous surgery. Barium swallow was ordered and the results showed soft tissue widening and dislocation of cervical plate (due to loosening of cervical plate) in prevertebral space. After ingestion of barium, leakage of contrast material from esophagus (around the device) was visible. This confirmed esophageal wall defect and probably infection in prevertebral / retroesophageal space. No evidence of obstruction along the esophagus was seen. Further investigations by cervical computed tomography (CT) with contrast and magnetic resonance imaging (MRI) did not verified abscess collection, although the other findings were compatible with the results of barium swallow. Cervical plate dislocation into prevertebral space and invasion into lumen of esophagus in the distance of 20 cm from incisors were confirmed by endoscopy.Neurosurgery consultation was done and elective surgery in cooperation with otolaryngologists was scheduled. After the surgery, the patient's symptoms relieved.Views related to barium swallow, CT, MRI, and endoscopy are attached to this report (figures 1-4).