title: Lymph node enlargement during combination therapy for chronic hepatitis C with pegylated interferon alpha and ribavirin: harmless reaction or harmful disease?
abstract: BACKGROUND
  Perihepatic lymph node enlargement (LNE) is often present in patients with chronic hepatitis C (CHC) and correlates with the degree of inflammation, as well as the stage of fibrosis of the liver. LNE at sites distant from the liver hilum, however, is not a common feature of chronic hepatitis but may occur during antiviral therapy as we report here.
  
  
  OBJECTIVE
  The aim of this study was to examine the frequency and aetiology of LNE at sites distant from the liver hilum in patients with chronic hepatitis C during combination therapy with pegylated interferon alpha and ribavirin.
  
  
  METHODS
  The charts of all patients undergoing therapy with PEG and RIBA for CHC at our institution from January 2002 to April 2003 were reviewed for those who developed de novo LNE at sites distant from the liver hilum.
  
  
  RESULTS
  In total, 8/217 patients (3.7%) or 5/125 patients treated within clinical trials (4.0%) were recorded to have developed de novo LNE during antiviral therapy.
  
  
  CONCLUSIONS
  LNE at various sites distant from the liver hilum was observed in up to 4% of our patients during treatment of CHC with PEG and RIBA. While being reactive in nature and resolving upon cessation of therapy in the majority of patients de novo LNE may be due to serious disease and warrants further investigations.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University Hospital of Zürich, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Wilhelmi
authors.forename: Christoph
authors.initials: C
authors.lastname: Gubler
authors.forename: Eberhard L
authors.initials: EL
authors.lastname: Renner
authors.forename: Beat
authors.initials: B
authors.lastname: Müllhaupt
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000009:adverse effects*; D008198:Lymph Nodes / Q000187:drug effects*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects*; D011994:Recombinant Proteins; D012254:Ribavirin / Q000008:administration & dosage / Q000009:adverse effects*; D013557:Switzerland
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a