title: Grade 4 febrile neutropenia and Fournier's Syndrome associated with triple therapy for hepatitis C virus: A case report.
abstract: The use of triple therapy for hepatitis C not only increases the rate of sustained virological responses compared with the use of only interferon and ribavirin (RBV) but also leads to an increased number of side effects. The subject of this study was a 53-year-old male who was cirrhotic with hepatitis C virus genotype 1 A and was a previous null non-responder. We initially attempted retreatment with boceprevir (BOC), Peg-interferon and RBV, and a decrease in viral load was observed in the 8(th) week. In week 12, he presented with disorientation, flapping, fever, tachypnea, arterial hypotension and tachycardia. He also exhibited leucopenia with neutropenia. Cefepime and filgrastim were initiated, and treatment for hepatitis C was suspended. A myelogram revealed hypoplasia, cytotoxicity and maturational retardation. After 48 h, he developed bilateral inguinal erythema that evolved throughout the perineal area to the root of the thighs, with exulcerations and an outflow of seropurulent secretions. Because we hypothesized that he was suffering from Fournier's Syndrome, treatment was replaced with the antibiotics imipenem, linezolid and clindamycin. After this new treatment paradigm was initiated, his lesions regressed without requiring surgical debridement. Triple therapy requires knowledge regarding the management of adverse effects and drug interactions; it also requires an understanding of the importance of respecting the guidelines for the withdrawal of treatment. In this case report, we observed an adverse event that had not been previously reported in the literature with the use of BOC.
authors.affiliation: Kelly Cristhian Lima Oliveira, Emili de Oliveira Bortolon Cardoso, Suzana Carla Pereira de Souza, Flávia Souza Machado, Carlos Eduardo Alves Zangirolami, Alecsandro Moreira, Giovanni Faria Silva, Cássio Vieira de Oliveira, Division of Gastroenterology, Department of Internal Medicine, Botucatu School of Medicine, 18618-970 São Paulo, Brazil.
authors.forename: Kelly Cristhian Lima
authors.initials: KC
authors.lastname: Oliveira
authors.affiliation: Kelly Cristhian Lima Oliveira, Emili de Oliveira Bortolon Cardoso, Suzana Carla Pereira de Souza, Flávia Souza Machado, Carlos Eduardo Alves Zangirolami, Alecsandro Moreira, Giovanni Faria Silva, Cássio Vieira de Oliveira, Division of Gastroenterology, Department of Internal Medicine, Botucatu School of Medicine, 18618-970 São Paulo, Brazil.
authors.forename: Emili de Oliveira Bortolon
authors.initials: Ede O
authors.lastname: Cardoso
authors.affiliation: Kelly Cristhian Lima Oliveira, Emili de Oliveira Bortolon Cardoso, Suzana Carla Pereira de Souza, Flávia Souza Machado, Carlos Eduardo Alves Zangirolami, Alecsandro Moreira, Giovanni Faria Silva, Cássio Vieira de Oliveira, Division of Gastroenterology, Department of Internal Medicine, Botucatu School of Medicine, 18618-970 São Paulo, Brazil.
authors.forename: Suzana Carla Pereira
authors.initials: SC
authors.lastname: de Souza
authors.affiliation: Kelly Cristhian Lima Oliveira, Emili de Oliveira Bortolon Cardoso, Suzana Carla Pereira de Souza, Flávia Souza Machado, Carlos Eduardo Alves Zangirolami, Alecsandro Moreira, Giovanni Faria Silva, Cássio Vieira de Oliveira, Division of Gastroenterology, Department of Internal Medicine, Botucatu School of Medicine, 18618-970 São Paulo, Brazil.
authors.forename: Flávia Souza
authors.initials: FS
authors.lastname: Machado
authors.affiliation: Kelly Cristhian Lima Oliveira, Emili de Oliveira Bortolon Cardoso, Suzana Carla Pereira de Souza, Flávia Souza Machado, Carlos Eduardo Alves Zangirolami, Alecsandro Moreira, Giovanni Faria Silva, Cássio Vieira de Oliveira, Division of Gastroenterology, Department of Internal Medicine, Botucatu School of Medicine, 18618-970 São Paulo, Brazil.
authors.forename: Carlos Eduardo Alves
authors.initials: CE
authors.lastname: Zangirolami
authors.affiliation: Kelly Cristhian Lima Oliveira, Emili de Oliveira Bortolon Cardoso, Suzana Carla Pereira de Souza, Flávia Souza Machado, Carlos Eduardo Alves Zangirolami, Alecsandro Moreira, Giovanni Faria Silva, Cássio Vieira de Oliveira, Division of Gastroenterology, Department of Internal Medicine, Botucatu School of Medicine, 18618-970 São Paulo, Brazil.
authors.forename: Alecsandro
authors.initials: A
authors.lastname: Moreira
authors.affiliation: Kelly Cristhian Lima Oliveira, Emili de Oliveira Bortolon Cardoso, Suzana Carla Pereira de Souza, Flávia Souza Machado, Carlos Eduardo Alves Zangirolami, Alecsandro Moreira, Giovanni Faria Silva, Cássio Vieira de Oliveira, Division of Gastroenterology, Department of Internal Medicine, Botucatu School of Medicine, 18618-970 São Paulo, Brazil.
authors.forename: Giovanni Faria
authors.initials: GF
authors.lastname: Silva
authors.affiliation: Kelly Cristhian Lima Oliveira, Emili de Oliveira Bortolon Cardoso, Suzana Carla Pereira de Souza, Flávia Souza Machado, Carlos Eduardo Alves Zangirolami, Alecsandro Moreira, Giovanni Faria Silva, Cássio Vieira de Oliveira, Division of Gastroenterology, Department of Internal Medicine, Botucatu School of Medicine, 18618-970 São Paulo, Brazil.
authors.forename: Cássio Vieira
authors.initials: CV
authors.lastname: de Oliveira
keywords: Adverse events; Boceprevir; Hepatitis C; Telaprevir; Treatment