Sarcoidosis associated with interferon-alpha therapy for chronic hepatitis C.
OBJECTIVE
Pulmonary side effects of interferon-alpha therapy of chronic hepatitis C seem to be rare. So far, only two cases of sarcoidosis in association with interferon-alpha treatment of chronic hepatitis C have been described.
We report on three patients who were treated with recombinant interferon-alpha2a for chronic hepatitis C, two of them in combination with ribavirin. These patients developed pulmonary sarcoidosis 12, 20 and 21 weeks, respectively, after beginning interferon therapy, one patient with Löfgren's syndrome. In one patient sarcoidosis emerged only after discontinuation of interferon therapy because of treatment failure. Clinical symptoms of sarcoidosis in the three patients were suggestive of side effects of interferon-alpha. Interferon therapy was discontinued and spontaneous remission was observed in all three cases 5, 6, and 8 months, respectively, after the onset of symptoms.


CONCLUSIONS
The occurrence of sarcoidosis in association with interferon-alpha therapy for chronic hepatitis C may have been underestimated so far. This could be due to the fact that symptoms of sarcoidosis and common side effects of interferon are similar, and sarcoidosis may occur after the end of interferon therapy. We hypothesize that interferon-alpha as a potent stimulator for T-helper 1 (Th1) immune responses may trigger the compartmentalized Th1 reaction that has been shown to take place in sarcoidosis.
Department of Medicine II, Klinikum Grosshadern, University of Munich, Germany.
R M
RM
Hoffmann
M C
MC
Jung
R
R
Motz
C
C
Gössl
H P
HP
Emslander
R
R
Zachoval
G R
GR
Pape
D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D005858:Germany; D019698:Hepatitis C, Chronic / Q000628:therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects* / Q000627:therapeutic use*; D008168:Lung / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D012075:Remission, Spontaneous; D012254:Ribavirin / Q000627:therapeutic use*; D017565:Sarcoidosis, Pulmonary / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D012867:Skin / Q000473:pathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D012254:Ribavirin