Systemic lupus erythematosus arising during interferon-alpha therapy for cryoglobulinemic vasculitis associated with hepatitis C.
We present the case of a 53-year-old woman who developed systemic lupus erythematosus (SLE) after being treated with interferon-alpha (IFN-alpha) for cryoglobulinemic vasculitis associated with hepatitis C virus (HCV) infection. Her cryoglobulinemic vasculitis resolved rapidly with IFN-alpha treatment. However, after 10 months of IFN-alpha therapy, she developed a photosensitive malar rash, oral ulcers, arthralgias, lymphopenia, and anti-SSA autoantibodies. She was diagnosed with SLE induced by IFN-alpha therapy. IFN-alpha was discontinued, she was treated with a short course of prednisone and hydroxychloroquine, and she improved rapidly. This is the first report of IFN-alpha-induced SLE complicating treatment of cryoglobulinemic vasculitis associated with HCV infection. The development of SLE during therapy with IFN-alpha could be due to direct immunomodulation by IFN-alpha, and review of experimental data and prior case reports suggests a pathogenic role for IFN-alpha in SLE.
Niewold
Timothy B
TB
Department of Rheumatology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. niewoldt@hss.edu
Swedler
William I
WI
D003449:Cryoglobulinemia / Q000188:drug therapy* / Q000821:virology; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects* / Q000276:immunology; D016898:Interferon-alpha / Q000009:adverse effects* / Q000276:immunology; D008180:Lupus Erythematosus, Systemic / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology; D008875:Middle Aged; D014657:Vasculitis / Q000188:drug therapy* / Q000821:virology
D007155:Immunologic Factors; D016898:Interferon-alpha