Sarcoidosis presenting with granulomatous uveitis induced by pegylated interferon and ribavirin therapy for hepatitis C

Abstract

Sarcoidosis is a systemic granulomatous disease that is triggered by an autoimmune process, and is now a well recognized but uncommon complication of antiviral therapy for Hepatitis C virus (HCV) infection, likely related to its immunomodulatory effects. The clinical presentation of HCV related sarcoidosis is as varied as systemic sarcoidosis, but ocular presentation alone has not been reported previously. We present a 23 year-old female who developed visual disturbances due to ocular sarcoidosis during the course of antiviral therapy for chronic HCV infection. Our case presentation is then followed by a review of the literature on the topic. We aim to stress the importance of screening for eye problems in following HCV patients undergoing antiviral therapy, and raise clinicians' awareness of sarcoidosis as a possible cause for eye problems even in the absence of respiratory complaints.

Ophthalmologic Complications in Children With Chronic Hepatitis C Treated With Pegylated Interferon

“…However, uveitis has also been reported to be due to interferon-induced sarcoidosis (21). Visual changes have been reported with interferon and are most commonly associated with retinopathy, ischemic optic nerve injury (22) or retinal vein thrombosis (23).…”

Sarcoid-Related Dacryoadenitis Following Treatment with Interferon Alpha and Ribavarin for Hepatitis C

“…Despite many reports of systemic sarcoid following interferon use for hepatitis C, cases of induced ophthalmic and orbital sarcoid remain rare. Five cases of presumed sarcoid uveitis following interferon use have been reported, although only 1 involved an ophthalmic presentation without prior systemic sarcoid (Yan et al, 2008). Sarcoid-like granulomatous dacryoadenitis, without any other features of sarcoidosis, has also recently been reported in a patient receiving interferon alpha and ribavarin (Hwang and Gausas, 2008).…”

Interferon-alpha-associated presumed ocular sarcoidosis

“…Also, Hirano et al published a case of uveitis in a patient with hilar and mediastinal lymph nodes enlargement by histologically proven sarcoidosis which developed 2 years after IFN-alpha treatment for chronic hepatitis C virus infection [19]. Recently, a case of sarcoidosis, presenting as granulomatous uveitis under therapy with pegylated IFN and ribavirin, was reported by Yan et al [44].…”

“…The most frequent are flu-like symptoms, autoimmune and autoinflammatory disorders, depression, and chronic fatigue syndrome [3,11,12,14,21,33,38,44]. The most common ocular side-effect of IFN-therapy is IFN-induced retinopathy [16,17].…”