Postpartum acute exacerbation of chronic hepatitis C with complete response to interferon-alpha.
We describe a patient with chronic hepatitis C who had severe postpartum acute exacerbation of the disease, with marked aminotransferase elevations and jaundice. The viral genotype was 2a, and the patient had a low viral load. Neither superinfection with another hepatotropic virus nor autoantibodies were evident. Markedly increased serum concentrations of T-helper (Th) 1-type cytokines and cytokine receptors, including interleukin (IL)-8, tumor necrosis factor (TNF)-alpha, soluble TNF receptor (sTNFR)-p55, sTNFR-p75, and soluble Fas antigen (sFas), as well as that of the Th 2-type cytokine, IL-10, were present. Complete biochemical and virologic response was achieved with interferon (IFN)-alpha treatment, which decreased cytokine elevations while favoring Th 1 dominance. Acute exacerbation of hepatitis C may occur when cellular immune responses are activated, as in late pregnancy and in the postpartum period. Treating such acute exacerbations immediately with IFN may be highly efficacious.
The Second Department of Internal Medicine, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
Makoto
M
Oketani
Toshihiko
T
Shibatou
Katsuhisa
K
Yamashita
Takushi
T
Arima
Terukatsu
T
Arima
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood / Q000628:therapy*; D006801:Humans; D007111:Immunity, Cellular; D016898:Interferon-alpha / Q000097:blood / Q000627:therapeutic use*; D011247:Pregnancy; D011644:Puerperal Disorders / Q000628:therapy*; D018121:Receptors, Cytokine / Q000097:blood; D019014:fas Receptor / Q000097:blood
D016898:Interferon-alpha; D018121:Receptors, Cytokine; D019014:fas Receptor; D000410:Alanine Transaminase; D001663:Bilirubin