title: Interstitial pneumonitis in a patient treated with alpha-interferon and ribavirin for hepatitis C infection.
abstract: Hepatitis C is a common infection with worldwide prevalence. It has a variable course and can lead to chronic hepatitis, cirrhosis and hepatocellular carcinoma. Until recently alpha-interferon (IFN-alpha) was the only effective treatment available. Combination therapy with IFN-alpha and ribavirin has been found to be more efficacious than IFN-alpha alone. Various side effects have been ascribed to interferon, such as arthralgias, myalgias, fatigue, and gastrointestinal and neuropsychiatric symptoms. Interstitial pneumonitis is a rare but known complication of IFN-alpha when given at a high dosage of 6 to 10 million units per day. Ribavirin is associated with dose-dependent hemolytic anemia, cough, dyspnea, rash, depression, and dyspepsia, although a potential role in interferon-induced interstitial pneumonitis has not been described. We describe a patient with an excellent clinical response of chronic hepatitis C to combination therapy with IFN-alpha at a dosage of 3 million units per day and ribavirin. The patient developed interstitial pneumonitis that resolved after discontinuation of IFN-alpha and ribavirin. Given that interstitial pneumonitis has previously been reported with high-dose IFN-alpha, this case suggests that this complication may occur with lower dosages of IFN-alpha, although a potential role for ribavirin in this disorder at present remains speculative.
authors.affiliation: Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
authors.forename: A
authors.initials: A
authors.lastname: Karim
authors.forename: S
authors.initials: S
authors.lastname: Ahmed
authors.forename: A
authors.initials: A
authors.lastname: Khan
authors.forename: H
authors.initials: H
authors.lastname: Steinberg
authors.forename: J
authors.initials: J
authors.lastname: Mattana
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D007370:Interferon Type I / Q000008:administration & dosage / Q000009:adverse effects*; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D012254:Ribavirin / Q000008:administration & dosage / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: D000998:Antiviral Agents; D007370:Interferon Type I; D011994:Recombinant Proteins; D012254:Ribavirin