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FATAL EXACERBATION OF HEPATITIS C- RELATED CRYOGLOBULINEMIA WITH
ALPHA- INTERFERON THERAPY.
Author: G Friedman, S Mehta, E Lamoureux and AH Sherker,
Division of Gastroenterology and Department of Pathology,
SMBD-Jewish General Hospital, McGill University, Montreal, Quebec,
Canada.
A 51 year old female with previously diagnosed transfusion-
related chronic hepatitis C presented with complaints of
hematochezia, bilateral sensori-motor peripheral neuropathy of her
hands, palpable purpura and dependent petechiae. The AST was 1.5
times normal but the other liver enzymes were normal. The serum
cryoglobulins and cryofibrinogen qualitative assays were positive.
A liver biopsy revealed chronic active hepatitis with cirrhosis.
Biopsy of her skin lesions revealed a leukocytoclastic vasculitis
and colonoscopy showed ulcerations which on histology were
consistent with vasculitic ulcers. Therapy with alpha-interferon at
3 million units thrice weekly was initiated for hepatitis C-related
cryoglobulinemia.
The patient tolerated the interferon poorly with severe nausea and
anorexia and was admitted to hospital with dehydration in the
second week of therapy. Shortly after admission, the patient's
peripheral neuropathy deteriorated to the point of functional
quadriplegia. Aggressive therapy against cryoglobulinemia including
plasmapheresis, intravenous immunoglobulins and high dose
corticosteroids was attempted. Despite this, the patient suffered
recurrent massive upper gastrointestinal bleeding secondary to
gastric vasculitis and severe metabolic acidosis. Coma ensued and
the patient eventually died from uncontrollable bleeding.
Based on several clinical trials, alpha-interferon is currently
considered to be the first line treatment for hepatitis C-related
cryoglobulinemia. This case demonstrates a severe exacerbation of
cryoglobulinemia temporally related to the initiation of alpha-
interferon therapy. In the future, caution should be exercised when
treating patients with alpha-Interferon for cryoglobulinemia.
Source: American Association for the Study of Liver Diseases
- 1996 Annual Meeting
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