Interferon-Ribavirin–associated Ischemic Colitis

Abstract

Interferon-alpha and ribavirin are widely used treatments for chronic hepatitis C. It is believed to be a cytokine made by T lymphocytes upon activation by foreign antigens. Complications of interferon and ribavirin therapy include systemic flulike symptoms, marrow suppression, emotional liability, auto immune reactions (especially auto immune thyroiditis) and miscellaneous side effects such as alopecia, rashes, diarrhea, numbness, and tingling of the extremities. With the possible exception of autoimmune thyroiditis, all these side effects are reversed upon dose lowering or cessation of therapy. We report a case of a 51-year-old man, with no previous history of vascular disease, who developed ischemic colitis after interferon-alpha and ribavirin therapy for chronic hepatitis C. In the literature, there have been only 2 published accounts associating interferon-alpha use with ischemic colitis in 2 patients. This report illustrates a better association of interferon-alpha and ribavirin with ischemic colitis.

Iatrogenic pathology of the intestines

“…95 Rare cases of ischaemic colitis associated with interferon-alpha (IFN-a) treatment for chronic hepatitis C (HCV) infection and metastatic cancer have been reported. [96][97][98] There have been isolated reports of ischaemic colitis associated with various other drugs, including alosetron, 99-101 pseudoephedrine, 102 dopamine, methysergide and NSAIDs. 2 Drugs, such as digitalis and diuretics, may predispose to ischaemic colitis in elderly patients in a state of low blood flow, often due to heart failure.…”

“…Ischaemic‐pattern colitis has been reported in association with a variety of drugs, including oral contraceptives, ergotamine derivatives, cocaine and, potentially, sumatriptan [a serotonin‐1 5‐hydroxytryptamine (5‐HT 1) receptor agonist] overuse . Rare cases of ischaemic colitis associated with interferon‐alpha (IFN‐α) treatment for chronic hepatitis C (HCV) infection and metastatic cancer have been reported . There have been isolated reports of ischaemic colitis associated with various other drugs, including alosetron, pseudoephedrine, dopamine, methysergide and NSAIDs .…”

Ischaemic colitis during interferon treatment for chronic hepatitis C: report of two cases and literature review

“…Therefore, because of its low prevalence, it is difficult to understand the clinical characteristics of this severe complication. To date, nine cases of ischaemic colitis during IFN therapy for chronic hepatitis C have been reported [7,8,10–14]. We have listed the clinical characteristics of these nine patients as well as our two patients in Table 1 and have summarized the findings in Table 2.…”

“…Ischaemic colitis is a common disease in the general population, and most patients are cured with conservative therapy; however, some patients show high rates of postoperative morbidity and mortality [9]. Although nine cases of ischaemic colitis during IFN therapy for chronic hepatitis C have been reported to date [7,8,10–14], IFN therapy was discontinued in most of these cases, and limited information is available regarding the safety of resuming IFN therapy after resolution of ischaemic colitis and subsequent recurrence.…”

Ischemic Colitis with Type I Interferons Used in the Treatment of Hepatitis C and Multiple Sclerosis: An Evaluation from the Food and Drug Administration Adverse Event Reporting System and Review of the Literature

“…In the literature review, there were 9 references identified, although 1 was eliminated due to the patients being on interleukin-2 as well as IFN-α. 14-17,19- 23 We identified 11 cases of IFN-α-induced IC reported in patients with HCV. The cases included had a temporal relationship in which the medication was administered before the event of IC and the patient had no other conditions or medications that were a more likely cause.…”