Hypothyroid myopathy as a complication of interferon alpha therapy for chronic hepatitis C virus infection

Ghilardi, Gottardo; Gonvers, J. J.; So, Avsarkisian

doi:10.1093/rheumatology/37.12.1349

Cited by 17 publications

(2 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Further laboratory testing may show an elevated IgG and mildly elevated serum bilirubin and alkaline phosphatase. This condition has been associated with other autoimmune phenomena, including ulcerative colitis, rheumatoid arthritis, anemia, myopathy, and thyroiditis (34)(35)(36)(37). Pertinent to this case, autoimmune thyroiditis has developed in association with DIAH in approximately 8-10% of cases (38,39).…”

Section: Discussionmentioning

confidence: 98%

Autoimmune Hepatitis and Thyroiditis Associated with Rifampin and Pyrazinamide Prophylaxis: An Unusual Reaction

et al. 2005

View full text Add to dashboard Cite

KEY WORDS: autoimmune hepatitis; autoimmune thyroiditis; rifampin prophylaxis; pyrazinamide prophylaxis.Drug-induced autoimmune hepatitis (DIAH) and thyroiditis with rifampin and pyrazinamide has not been reported to our knowledge. We report on a 25-year-old male who presented with signs of acute anicteric hepatitis and subclinical thyroiditis 3 weeks after starting antituberculosis (anti-TB) prophylaxis. After discontinuation of the rifampin and pyrazinamide prophylaxis, his symptoms of hepatitis resolved, and liver enzymes and thyroid tests returned to normal after several months. Since neither rifampin nor pyrazinamide has been described so far as a triggering factor for autoimmune hepatitis and thyroiditis, the case is discussed and the literature reviewed. CASE REPORTA 25-year-old man in otherwise excellent health presented 3 weeks after the start of anti-TB prophylaxis. He was found to have a positive purified protein derivative (PPD) in May 2002 that was performed as part of a routine employment physical examination. A PPD 2 years earlier had been negative. He was unable to recall any exposure to TB, but he was a medical student at an urban medical center. A chest x-ray taken after the PPD was found to be unremarkable. The patient chose not to start anti-TB prophylaxis at this time, as he was asymptomatic. However, in October 2002, he was convinced to start a 2-month regimen of rifampin and pyrazinamide prophylaxis, which was the guideline at that time for treatment of latent TB (1). Three weeks after beginning prophylaxis, he presented with anorexia, fever, fatigue, and right upper quadrant pain. Physical examination was unremarkable except for mild right upper quadrant tenderness on deep palpation. No organomegaly or tenderness Manuscript . was noted. No skin eruption was present. The patient was a nonsmoker, but did consume alcohol, up to two six-packs of beer on the weekends. He had no other comorbid conditions. Aminotransferases at presentation were elevated, with an ALT of 749 IU/L (normal, 0-40 IU/L) and an AST of 938 IU/L (normal, 0-40 IU/L). Preprophylaxis baseline ALT and AST had been normal (12 and 22 IU/L, respectively). Serum total protein was 6.7 g/dL (normal, 6.0-8.5 g/dL), serum albumin was 3.8 g/dL (normal, 3.5-5.0 g/dL), and serum globulin was 2.9 g/dL (1.5-3.0 g/dL). Blood work also revealed an eosinophil count of 15%. Serological studies showed a positive antinuclear antibody (ANA) of >1:640 in a speckled pattern. Anti-smooth muscle antibody (ASMA) was elevated, at 1:80. Tests for acute and chronic viral infection, including hepatitis A, B, and C, mononucleosis, and cytomegalovirus, were all negative. Iron and copper studies were normal, and an abdominal ultrasound was unremarkable with normal echogenicity of the liver. One week after discontinuation of rifampin and pyrazinamide, the ALT was further elevated, to 1256 IU/L, and AST was 695 IU/L. INR was slightly prolonged, at 1.4 (normal, 0.9-1.1), but the bilirubin level was normal at 0.4 mg/dL (normal, 0.1-1.0 mg/dL). No liver biopsy w...

show abstract

Section: Discussionmentioning

confidence: 98%

Autoimmune Hepatitis and Thyroiditis Associated with Rifampin and Pyrazinamide Prophylaxis: An Unusual Reaction

et al. 2005

View full text Add to dashboard Cite

show abstract

“…[7] A diminished energetic consumption is related partially to a transition in the myosin isoforms, which express a slower adenosine triphosphatase, and to an impairment of the trans sarcolemmal transports. All of these factors may contribute to muscle weakness, fatigue, and exertional pain.…”

Section: Discussionmentioning

confidence: 99%

Uncommon presentation of a common disorder

Sowmini

Jawahar

Bhanu

2013

Ann Indian Acad Neurol

View full text Add to dashboard Cite

We report about a young male who presented with generalized muscle stiffness, involving the limb, facial, and paraspinal muscles. The stiffness was severe enough to restrict all his daily activities, progressively increased with movements and also produced recurrent falls. This clinical picture resembled one of stiff person syndrome. As he had hypertrophy of calf muscles and generalized muscle tautness he was evaluated for other disorders which can resemble stiff person syndrome. Investigations revealed severe hypothyroidism with thyroid antibodies being elevated. This case is reported to highlight the fact that myopathy as a presenting manifestation of hypothyroidism can simulate stiff person syndrome. It is essential to identify the condition early as it recovers fully with treatment. Our patient responded well to thyroid replacement therapy and was able to lead a normal life.

show abstract

Retraction notice

Stübgen

2009

Muscle and Nerve

View full text Add to dashboard Cite

Hypothyroid myopathy as a complication of interferon alpha therapy for chronic hepatitis C virus infection

Cited by 17 publications

References 4 publications

Autoimmune Hepatitis and Thyroiditis Associated with Rifampin and Pyrazinamide Prophylaxis: An Unusual Reaction

Autoimmune Hepatitis and Thyroiditis Associated with Rifampin and Pyrazinamide Prophylaxis: An Unusual Reaction

Uncommon presentation of a common disorder

Retraction notice

Contact Info

Product

Resources

About