[Peripheral polyneuropathy and bilateral optic neuropathy during treatment of chronic hepatitis C].
METHODS
A 54-year-old female patient with recently confirmed chronic hepatitis C, genotype Ib and positive HCV-RNA was admitted for interferon induction therapy.


RESULTS
Physical examination findings were normal. Ultrasound examination of the abdomen revealed slightly compacted liver structure with otherwise no pathological findings. Laboratory results showed marginally increased GPT value at 46 U/l with HCV-RNA of 769,000 U/ml. All other laboratory results were within the reference range. There was no indication for autoantibodies.


RESULTS
After one-week induction therapy with interferon-alpha (IFN-alpha2a) plus ribavirin and amantadine, maintenance therapy with pegylated interferon-alpha (PEG-IFN-alpha2a) plus ribavirin and amantadine was initiated. Complete virus elimination was achieved after two and a half months. Five months after onset of therapy, painful peripheral neuropathy of the limbs occured and after one more month, severe vision impairment with opticus neuropathy and bilateral papilledema developed. Simultaneously, peripheral polyneuropathy progressed with additional motoric deficits. Interferon therapy was terminated and the patient received high-dose corticosteroids which resulted in an improvement of neuropathic complaints. Eight months later, only discrete bilateral vision impairment with optic nerve atrophy remained.


CONCLUSIONS
Side effects occurring with interferon-alpha therapy and pegylated interferon-alpha therapy are generally low and well tolerated. However, in individual cases - as in our patient - side effects including severe peripheral neuropathy and optic neuropathy have been observed. In these cases, interferon therapy must be terminated immediately as severe damage of nerves may result.
Chrissafidou
A
A
Abteilung für Innere Medizin, Marienhospital Bottrop. achrissaf@web.de
Musch
E
E
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000547:Amantadine / Q000627:therapeutic use; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000139:chemically induced* / Q000188:drug therapy; D010211:Papilledema / Q000139:chemically induced / Q000188:drug therapy; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced* / Q000188:drug therapy; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000627:therapeutic use; D011994:Recombinant Proteins; D012254:Ribavirin / Q000627:therapeutic use; D016896:Treatment Outcome; D014786:Vision Disorders / Q000139:chemically induced / Q000188:drug therapy
D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; D000547:Amantadine; C100416:peginterferon alfa-2a