Pneumococcal meningitis during antiviral treatment with interferon and ribavirin in a splenectomized patient with chronic hepatitis C - do not miss vaccination before starting therapy.
We report on a 35-year-old man who developed pneumococcal meningitis while receiving antiviral therapy with interferon (consensus interferon, CIFN) and ribavirin for chronic hepatitis C. Antibiotic therapy was started four days after the onset of symptoms. Unfortunately, the patient developed a persisting right-sided cochlear hearing impairment. Antiviral therapy led to sustained viral response of hepatitis C. At the age of 14 years he had experienced a hemorrhagic shock after a traffic accident, received multiple blood transfusions and undergone a splenectomy. He had not received vaccination against Streptococcus pneumoniae. This case report reminds us that splenectomized patients without previous pneumococcal vaccination should receive such vaccination before immunomodulatory treatment.
Hadem
J
J
Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Carl-Neuberg-Str. 1,30625 Hannover, Germany. hadem.johannes@mhhannover.de
Cornberg
M
M
Hauptmann
C
C
Süttmann
U
U
Manns
M P
MP
Wedemeyer
H
H
D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001426:Bacterial Proteins; D002439:Cefotaxime / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D046088:Hearing Loss, Unilateral / Q000209:etiology; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D007370:Interferon Type I / Q000009:adverse effects* / Q000627:therapeutic use; D016898:Interferon-alpha; D008297:Male; D008586:Meningitis, Pneumococcal / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control*; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control*; D010400:Penicillin G / Q000008:administration & dosage; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins; D012254:Ribavirin / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D013156:Splenectomy
D000998:Antiviral Agents; D001426:Bacterial Proteins; D007370:Interferon Type I; D016898:Interferon-alpha; C500900:PavA protein, Streptococcus pneumoniae; D022242:Pneumococcal Vaccines; D011994:Recombinant Proteins; D012254:Ribavirin; C050739:interferon alfacon-1; D002439:Cefotaxime; D010400:Penicillin G