title: Interferon-alpha-induced sarcoidosis in a patient being treated for hepatitis C.
abstract: METHODS
  Female, 43 FINAL DIAGNOSIS: -
  
  
  METHODS
  Diarrhea • generalized weakness • headache • lightheadedness • nausea • rash • short of breath • vomiting
  
  
  METHODS
  - Clinical Procedure: - Specialty: Pulmonology.
  
  
  OBJECTIVE
  Rare diseae.
  
  
  BACKGROUND
  IFN-alpha-2b in combination with ribavirin is now the standard of care for the treatment of hepatitis C. Sarcoidosis is a chronic multisystem granulomatous disorder characterized by noncaseating granulomas in the involved organs. The pathologic hallmark of sarcoidosis is the presence of noncaseating granulomas in the interstitium that typically involve the lymphatics.
  
  
  METHODS
  A 43-year-old woman presented to our care with 2-week history of nausea, vomiting, diarrhea, shortness of breath, migraine headache, maculopapular rash, generalized weakness, and lightheadedness. She had been treated for hepatitis C with telaprevir, ribavirin, and interferon-alpha-2b for 6 months. Chest radiograph showed bilateral diffuse prominence of bronchovascular markings. CT of the chest revealed bilateral diffuse centrilobular nodules with associated intralobular septal thickening, thickening of the central peribronchovascular interstitium, nodularity of the major fissures, and mediastinal lymphadenopathy. These findings were suspicious for atypical pulmonary sarcoidosis, possibly interferon-induced. The pathology of the mediastinal lymph node biopsy revealed noncaseating granulomatous inflammation consistent with the diagnosis of pulmonary sarcoidosis. Pathology of the skin punch biopsy showed giant-cell granulomatous inflammation without necrosis. The patient was started on prednisone 40 mg daily with a steroid tapering course for 8 weeks.
  
  
  CONCLUSIONS
  The management of IFN-induced sarcoidosis includes the discontinuation of IFN therapy with or without the administration of systemic corticosteroids. With the increasing prevalence of HCV in the United States, it is likely that more IFN-alpha-induced sarcoidosis will be encountered by clinicians.
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: Remi
authors.initials: R
authors.lastname: Trien
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: Chad J
authors.initials: CJ
authors.lastname: Cooper
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: David
authors.initials: D
authors.lastname: Paez
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: Edgardo
authors.initials: E
authors.lastname: Colon
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: Shajeea
authors.initials: S
authors.lastname: Ajmal
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: Hasan
authors.initials: H
authors.lastname: Salameh
keywords: Hepatitis C; Interferons - adverse effects; Sarcoidosis - chemically induced