Consensus Interferon Induced Interstitial Pneumonitis in a Patient with HCV

Hillier, Amy; Mand, Jasminder; Ahmed, Rayaz; Markov, M. A.; Nadir, Abdul

doi:10.1111/j.1572-0241.2006.00393_3.x

Cited by 9 publications

(5 citation statements)

References 6 publications

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“…[16]Female43‡α-2b12080048Dyspnea, cough, feverDeathHillier et al. [17]Female68CaucasianConsensus IFN9 μg daily1,0008Shortness of breathDiscontinued and steroidsRenou et al. [18]Female58Caucasianα-2bα-2a1501801,0001,000 + A*1212DyspneadyspneaDiscontinued and resolved with inhalation steroidsKumar et al.…”

Section: Resultsmentioning

confidence: 99%

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Pneumonitis as A Consequence of (Peg)Interferon-Ribavirin Combination Therapy for Hepatitis C: a Review of the Literature

2009

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Combination of peginterferon and ribavirin is the current therapy for chronic hepatitis C infection (HCV). Interstitial pneumonitis is a rare side-effect of HCV therapy and is an important cause of dose reduction or discontinuation, impairing success of antiviral therapy. We performed a review of the literature in order to present diagnostic modalities and possible treatments for pneumonitis and to offer guidelines. We searched for cases where pneumonitis as a side-effect of HCV treatment was documented. First we performed a literature search via PubMed and Web of Science interface and second we searched three drug toxicity databases. We systematically analyzed all case reports with respect to clinical manifestations, type of treatment, and outcome. A literature search revealed 19 articles, containing 25 case descriptions, while we traced 33 cases from the drug toxicity databases. Pneumonitis presented with any of the combination of fever, dyspnea, and cough and can arise with any type of (conventional or pegylated) interferon. Mortality secondary to pneumonitis was seen in 7% of cases, exclusively with peginterferon α-2b. In most cases therapy was discontinued and steroids were started. Interferon-induced pneumonitis during HCV treatment is a severe complication and should be recognized in order to prevent further pulmonary damage and/or death.

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Section: Resultsmentioning

confidence: 99%

“…Intravenous therapy with 180 mg/day methylprednisolone was started in one case [14], while other authors started with 125 mg/day prednisolone [15, 16]. Others started patients on oral steroid therapy (40 mg) [6, 17, this study], while two authors initiated inhalation steroids [18, 19]. …”

Section: Resultsmentioning

confidence: 99%

Pneumonitis as A Consequence of (Peg)Interferon-Ribavirin Combination Therapy for Hepatitis C: a Review of the Literature

2009

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“…IFN‐α and PEG‐IFN‐α are known to result in mild pulmonary side effects . Rarely, patients experience severe pulmonary toxicities, including interstitial pneumonitis, sarcoidosis, and bronchiolitis obliterans organizing pneumonia . The mechanism of IFN‐mediated pulmonary toxicity has been proposed to relate to its immunomodulatory activities, including the induction of pro‐inflammatory and pro‐fibrogenic cytokines .…”

Section: Discussionmentioning

confidence: 99%

Randomized, controlled pharmacokinetic and pharmacodynamic evaluation of albinterferon in patients with chronic hepatitis B infection

Tanwandee

Piratvisuth

Thongsawat

et al. 2014

J of Gastro and Hepatol

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“…Pegylated interferon-alpha (PEG-IFN-α) is a commonly used antiviral drug for treating chronic hepatitis C virus (HCV) infection. However, it can have rare but severe side effects, such as undifferentiated connective tissue disease (UCTD), a condition characterized by symptoms suggestive of an autoimmune disease without meeting specific criteria for a specific connective tissue disease [1]. Another significant complication is interstitial pneumonitis (IP), which involves inflammation and fibrosis of the lung tissue, leading to breathing difficulties and impaired lung function [2].…”

Section: Introductionmentioning

confidence: 99%

Excessive Dynamic Airway Collapse After Entecavir Use in a Patient With Pegylated Interferon-Induced Undifferentiated Connective Tissue Disease and Entecavir Use to Prevent Hepatitis B Virus Reactivation Upon Giving Rituximab

Akhtar,

Tayab,

Nawaz

et al. 2024

Cureus

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Pegylated interferon-alpha (PEG-IFN-α) is an antiviral medication used to treat chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infections. It may result in rare but severe side effects, such as undifferentiated connective tissue disease (UCTD) and excessive dynamic airway collapse (EDAC), which can occur as delayed complications of PEG-IFN-α-induced UCTD. In cases where these complications arise, entecavir, employed for treating HBV infection, may be considered. A 49-year-old female patient, monitored for nine years with HCV and a viral load of 1.5 million, genotype 3, and normal liver function tests (LFTs), possibly acquired the infection from her HCV-positive husband. The patient was initially treated with PEG-IFN-α (IFN-α-2b, 100 µg/week subcutaneously) and ribavirin (RBV, 500 mg/twice daily). Following the sixth injection, the patient exhibited symptoms, including shortness of breath and cough, leading to limited daily activities. Subsequent high-resolution computed tomography (HRCT) showed interstitial pneumonitis (IP) signs. She was given a high dose of steroids. Over the next two to four weeks, the patient experienced Raynaud's phenomenon, skin tightening, joint pains, and dryness of the eyes and mouth. The antinuclear antibody (ANA) test was negative, while the extractable nuclear antigen (ENA) test showed equivocal anti-Smith antibodies (6.38). Rheumatoid factor (RA) factors were mildly positive, and pulmonary function tests (PFTs) indicated a restrictive pattern. The patient was intolerant to hydroxychloroquine (HCQ) and azathioprine (Imuran) 500 mg, subsequently receiving mycophenolate mofetil 500 mg/thrice daily. Despite four years of treatment, UCTD due to PEG-IFN-α remained difficult to control; however, IP responded well to steroids. Rituximab pulse therapy was planned before the initiation; serological tests showed positive anti-HBs with a titer of 17.02, positive anti-HBc, but negative HBsAg and undetectable HBV viral load, indicating immunity to HBV due to natural infection. Given the potential for rituximab to cause immunosuppression and HBV reactivation, entecavir treatment was started and continued for 18 months. The patient was followed for another five years, during which her LFTs and viral markers showed stability. However, after nine years of PEG-IFN-α-induced UCTD disorder, she experienced a reoccurring cough but was unresponsive to steroids that were against her suspicion of a flare of IP. A subsequent dynamic CT scan detected a 75% trachea collapse while in a supine position, indicating a potential complication termed EDAC. This EDAC could not be linked to PEG-IFN-α-induced UCTD disorder or EDAC after the use of entecavir in a patient with PEG-IFN-α-induced UCTD disorder. Treatment of such complex patients requires flexible, specific treatment plans and continuous monitoring. This case emphasizes the need for caution in patients with a history of IFN-induced disease and the possibility of late effects and possible effects of the use of entecavir in a patient with PEG...

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Consensus Interferon Induced Interstitial Pneumonitis in a Patient with HCV

Cited by 9 publications

References 6 publications

Pneumonitis as A Consequence of (Peg)Interferon-Ribavirin Combination Therapy for Hepatitis C: a Review of the Literature

Pneumonitis as A Consequence of (Peg)Interferon-Ribavirin Combination Therapy for Hepatitis C: a Review of the Literature

Randomized, controlled pharmacokinetic and pharmacodynamic evaluation of albinterferon in patients with chronic hepatitis B infection

Excessive Dynamic Airway Collapse After Entecavir Use in a Patient With Pegylated Interferon-Induced Undifferentiated Connective Tissue Disease and Entecavir Use to Prevent Hepatitis B Virus Reactivation Upon Giving Rituximab

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