1/62. Triggering of acute alcoholic hepatitis by alpha-interferon therapy.BACKGROUND/AIMS: Alcohol may induce autoimmunity by recognition of acetaldehyde-modified proteins which may be implicated in the pathogenicity of acute alcoholic hepatitis. We report here the potential role of alpha-interferon, a potent inducer of the autoimmunity process, in inducing alcoholic hepatitis. methods: We analyzed clinical, biological, virological and histological features in two cases where alpha-interferon treatment for HCV-related hepatitis led to a marked increase in aminotransferase activities. RESULTS: alpha-interferon as treatment of HCV-related hepatitis seemed to exacerbate acute alcoholic hepatitis despite moderate alcohol consumption. In Case 1, moderate daily alcohol intake of 40 g during therapy led to biopsy-proven acute alcoholic hepatitis, while the same consumption before therapy did not. In Case 2, before treatment, the liver biopsy showed mild acute alcoholic hepatitis; aminotransferases increased during alpha-interferon therapy, although no increase in alcohol intake was observed. CONCLUSION: alpha-interferon therapy by its immunomodulatory properties could be implicated in alteration of the course of acute alcoholic hepatitis. These observations emphasize that the decision to treat with alpha-interferon when there is even moderate alcohol consumption should be carefully weighted in HCV-infected patients.- - - - - - - - - - ranking = 1keywords = unit (Clic here for more details about this article) |
2/62. Autoimmune thyroiditis and myelosuppression following treatment with interferon-alpha for hepatitis c.CASE: We describe the case of a 48-year-old woman from thailand diagnosed with chronic hepatitis c, who experienced a suppression of all blood cell counts accompanied by a newly developed clinically manifested autoimmune thyroid disorder after treatment with interferon alpha-2b (INF-alpha) 46 days after beginning of therapy a decrease of platelet, red and white blood cell counts became obvious. Concomitantly we observed an increase of FT4 and FT3 with a totally depressed TSH level 80 days after starting INF-alpha administration. Antibody assessment resulted in detection of high numbers of antithyroid-microsomal antibodies and antithyroglobulin antibodies. Thyroid hormone levels normalized under treatment with methimazole/propylthiouracil within 4.5 months. However, two months after cessation of antithyroid therapy increasing TSH levels and decreasing FT4 levels indicated a new tendency towards a hypothyroid state. CONCLUSION: We classify this case as an interferon-alpha-induced disorder of thyroid function accompanied by myelosuppression. A close monitoring for thyroid dysfunction, e.g. evaluation of TSH-levels before and after administration of INF-alpha is mandatory.- - - - - - - - - - ranking = 826.35656726956keywords = count (Clic here for more details about this article) |
3/62. Acquired factor viii inhibitor in a non-hemophilic patient with chronic hepatitis c viral infection.Production of coagulation factor viii inhibitor is rarely encountered in non-hemophilic patients. A 63-year-old Japanese male suffered from severe bleeding tendency caused by this inhibitor. Although he did not have malignancy or collagen disease, he had chronic hepatitis c virus (HCV) infection. Although HCV is known to induce production of various autoimmune antibodies, this may be the first report of a case with both acquired factor viii inhibitor and HCV infection.- - - - - - - - - - ranking = 413.17828363478keywords = count (Clic here for more details about this article) |
4/62. Photoallergic skin reaction to ribavirin.A 65-yr-old woman with chronic hepatitis c was treated with three million units interferon-alpha t.i.w. and 1000 mg ribavirin daily. At wk 16 of combination therapy the patient developed an itchy eczematous erythema, partly of urticarial character, which was almost confined to ultraviolet (UV)-exposed sites. Histopathological examination of the skin lesions was consistent with a photoallergic reaction. The minimal erythematous dose for UVA and UVB was assessed on healthy skin. After 24 h, a distinct erythema at the UVB irradiated site was found, whereas no reaction was seen with UVA provocation up to a dose of 10 J/cm2. Correspondingly, determination of the absorption spectrum of ribavirin revealed maximum absorption within UVB at 282.5 nm. ribavirin was stopped, and the cutaneous lesions and pruritus completely disappeared without subsequent hyperpigmentation. This case indicates that ribavirin is a potential photosensitizer for UVB, which may become increasingly relevant in patients with chronic hepatitis c undergoing combination therapy for 6-12 months with interferon-alpha and ribavirin.- - - - - - - - - - ranking = 0.5keywords = unit (Clic here for more details about this article) |
5/62. A case of interferon alpha-induced manic psychosis in chronic hepatitis c.It is well known that mood disorder such as depression occasionally develops during interferon (IFN) therapy for chronic viral hepatitis. So far, however, IFN-induced manic disorder has been rarely reported. We present a case of manic psychosis which developed during IFN treatment for chronic hepatitis c. A 35-year-old man with chronic hepatitis positive for hepatitis c virus rna in serum was treated with natural IFN alpha with a daily dosage of 5 million units. Six weeks later he complained of insomnia, and then became exhilarated, talkative, restless and aggressive. Since the mental state was compatible with manic disorder, IFN therapy was immediately ceased. Simultaneously, psychotropic drugs were administered. One week later, the psychiatric disturbances disappeared. He has been keeping his usual social interactions without the psychotropic drugs after that. It is suggested that manic psychosis happened secondary to IFN alpha treatment.- - - - - - - - - - ranking = 0.5keywords = unit (Clic here for more details about this article) |
6/62. A conservative triple antioxidant approach to the treatment of hepatitis c. Combination of alpha lipoic acid (thioctic acid), silymarin, and selenium: three case histories.BACKGROUND: There has been an increase in the number of adults seeking liver transplantation for hepatitis c in the last few years and the count is going up rapidly. There is no reliable and effective therapy for chronic hepatitis c since interferon and antivirals work no more than 30% of the time, and liver transplant surgery is uncertain and tentative over the long run. This is because, ultimately, residual hepatitis c viremia infects the new liver. Furthermore, liver transplantation can be painful, disabling and extremely costly. TREATMENT PROGRAM: The author describes a low cost and efficacious treatment program in 3 patients with cirrhosis, portal hypertension and esophageal varices secondary to chronic hepatitis c infection. This effective and conservative regimen combines 3 potent antioxidants (alpha-lipoic acid [thioctic acid], silymarin, and selenium) that possess antiviral, free radical quenching and immune boosting qualities. CONCLUSION: There are no remarkably effective treatments for chronic hepatitis c in general use. Interferon and antivirals have less than a 30% response rate and because of the residual viremia, a newly transplanted liver usually becomes infected again. The triple antioxidant combination of alpha-lipoic acid, silymarin and selenium was chosen for a conservative treatment of hepatitis c because these substances protect the liver from free radical damage, increase the levels of other fundamental antioxidants, and interfere with viral proliferation. The 3 patients presented in this paper followed the triple antioxidant program and recovered quickly and their laboratory values remarkably improved. Furthermore, liver transplantation was avoided and the patients are back at work, carrying out their normal activities, and feeling healthy. The author offers a more conservative approach to the treatment of hepatitis c, that is exceedingly less expensive. One year of the triple antioxidant therapy described in this paper costs less than $2,000, as compared to mor than $300,000 a year for liver transplant surgery. It appears reasonable, that prior to liver transplant surgery evaluation, or during the transplant evaluation process, the conservative triple antioxidant treatment approach should be considered. If these is a significant betterment in the patient's condition, liver transplant surgery may be avoided.- - - - - - - - - - ranking = 413.17828363478keywords = count (Clic here for more details about this article) |
7/62. The effect of combination therapy with interferon and cryofiltration on mesangial proliferative glomerulonephritis originating from mixed cryoglobulinemia in chronic hepatitis c virus infection.Cryofiltration, which has developed from double filtration plasmapheresis (DFPP) with a cooling unit, is an on-line technique to remove cryoglobulin. We report on a patient who suffered from progressive edema and renal insufficiency caused by cryoglobulinemic membranoproliferative glomerulonephritis (MPGN), probably due to chronic hepatitis c virus (HCV) infection. To remove cryoglobulins and terminate the HCV infection, we utilized combination therapy with cryofiltration and interferon-alpha injection with corticosteroids. interferon-alpha was capable of decreasing proteinuria but not diminishing cryoglobulin. Additional cryofiltration could remove cryoglobulin to an undetectable level. This combination therapy was partially successful to reduce proteinuria and prevent the progressive deterioration of renal function. The major adverse effects of this therapy were bleeding and myelosuppression. We conclude that this combination therapy may be effective and should be considered as treatment for cryoglobulinemic MPGN.- - - - - - - - - - ranking = 0.5keywords = unit (Clic here for more details about this article) |
8/62. ticlopidine induced prolonged leucopenia in a patient with immunocytoma and chronic hepatitis c.ticlopidine is increasingly used in the secondary prophylaxis in patients with arterial occlusive diseases. neutropenia is a well known side effect of this drug. We report a case of a 73 year old woman who was admitted because of severe prolonged ticlopidine induced leucopenia. The past medical history included an immunocytoma of the IgM-kappa type diagnosed seven years ago with less than 10% infiltration of the bone marrow and a chronic hepatitis c. On admission the white cell count was 1000/microL. ticlopidine was stopped. The white cell count did not increase within one week, thus filgastrim was applied on two consecutive days. The leucocyte count promptly increased to 6000/microL but consecutively dropped within the next fortnight again to levels below 500/microL forcing daily filgastrim application for another 9 days. Four months after the initiation of the therapy with filgastrim the patient had a white cell count of 4300/microL. We therefore conclude that in patients with a history of potentially bone marrow suppressing diseases the use of ticlopidine has to be carefully weighed against possible myelosuppressive effects.- - - - - - - - - - ranking = 1652.7131345391keywords = count (Clic here for more details about this article) |
9/62. Severe strongyloidiasis during interferon plus ribavirin therapy for chronic HCV infection.ribavirin is a nucleoside analogue, recently introduced in hepatitis c virus (HCV) therapy, that has postulated immunomodulatory and immunosuppressive action. strongyloidiasis is an helmintic infection caused by strongyloides stercoralis, endemic in tropical countries. Severe strongyloidiasis has been demonstrated after immunosuppression by corticosteroids evolving some fatal cases. Here, we describe two cases of severe strongyloidiasis coincident with ribavirin plus interferon therapy for treating HCV infection. The review of our monotherapy protocol with interferon did not disclose any case of symptomatic strongyloidiasis pointing to a possible role of ribavirin in modifying immune response to S. stercoralis. We propose a careful screening for S. stercoralis before initiating ribavirin therapy or even empiric antihelmintic treatment.- - - - - - - - - - ranking = 413.17828363478keywords = count (Clic here for more details about this article) |
10/62. Extensive psoriasis induced by interferon alfa treatment for chronic hepatitis c.A 47 year old man with chronic hepatitis c was treated with interferon alfa, 3 million units three times a week, and developed widespread plaque psoriasis within weeks of starting interferon therapy. There was no previous history of psoriasis. The psoriasis was characterised by extensive nail involvement and plaques at the interferon injection sites. The patient relapsed after a total of 12 months of interferon and was subsequently treated with interferon and tribavirin (ribavirin) with recurrence of the psoriasis.- - - - - - - - - - ranking = 0.5keywords = unit (Clic here for more details about this article) |
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