title: Induction of cytoplasmic pattern in the form of "rods and rings" through the treatment of hepatitis C: a case report.
abstract: Female patient, complaining of weakness and pain in hypogastric, was admitted to the emergency department of the University Hospital of the West of Paraná (HUOP). During the interview reported treatment of chronic infection with hepatitis C virus (HCV) with peginterferon and ribavirin. Among the laboratory tests ordered, the search for self-antibodies against cellular antigens, traditionally known as antinuclear factor, showed fluorescence shaped like rods and/or rings in the cytoplasm of cells. This study attempts to clarify the relationship between this pattern not yet completely understood and the clinical picture of the patient. This pattern is characterized by 3-10 μm rods or rings with 2-5 μm in diameter scattered throughout the cytoplasm of the cell. Therefore, this new standard has been designated as "rods and rings" (RR). The antigenic target of this reaction was identified as inosine-5'-monophosphate dehydrogenase type 2 (IMPDH2) which is a key enzyme in the synthesis of purine nucleotides. The IMPDH2 enzyme aggregated or modified shaped RR in those patients treated with ribavirin may become antigenic and induce an autoimmune response. It is possible that interferon alpha stimulates the occurrence of anti-RR reactivity apparently induced by ribavirin. So far it is not known why the standard RR in HEp2 cells occurs only in a fraction of patients with HCV. Previous studies presented in this paper allow affirming that these antibodies associated with the standard RR are strongly related to hepatitis C. Moreover, it can be stated that the occurrence of anti-RR reactivity is promoted by combination therapy with interferon and ribavirin.
authors.affiliation: Laboratório de Análises Clínicas do Hospital Universitário do Oeste do Paraná, Florianópolis, SC, Brasil. Electronic address: marianofelisberto@hotmail.com.
authors.forename: Mariano
authors.initials: M
authors.lastname: Felisberto
authors.affiliation: Universidade Estadual do Oeste do Paraná (Unioeste), Florianópolis, SC, Brasil.
authors.forename: Alex Sandro
authors.initials: AS
authors.lastname: Jorge
authors.affiliation: Universidade Estadual do Oeste do Paraná (Unioeste), Florianópolis, SC, Brasil.
authors.forename: Rafael Andrade
authors.initials: RA
authors.lastname: Menolli
authors.affiliation: Laboratório de Análises Clínicas do Hospital Universitário do Oeste do Paraná, Florianópolis, SC, Brasil.
authors.forename: Laísa Vieira
authors.initials: LV
authors.lastname: Gnutzmann
authors.affiliation: Laboratório de Análises Clínicas do Hospital Universitário do Oeste do Paraná, Florianópolis, SC, Brasil.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Nesi
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D003593:Cytoplasm / Q000648:ultrastructure*; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans
chemical_list: D000998:Antiviral Agents
keywords: Autoanticorpos; Bastões e anéis; Cytoplasmic pattern; Hepatite C; Hepatitis C; Padrão citoplasmático; Rods and rings; Self‐antibodies