title: Severe immune thrombocytopenia after peg-interferon-alpha2a, ribavirin and telaprevir treatment completion: A case report and systematic review of literature.
abstract: Mild to moderate autoimmune thrombocytopenia (AITP) is a common finding in patients receiving interferon-based antiviral treatment, due to bone marrow suppression. Here we report the case of a patient with chronic genotype 1b hepatitis C virus (HCV) infection treated with pegylated-interferon alpha-2a, ribavirin and telaprevir for 24 wk; the patient developed severe AITP three weeks after treatment withdrawal. We performed a systematic literature search in order to review all published cases of AITP related to HCV antiviral treatment. To our knowledge, this is the second case of AITP observed after antiviral treatment withdrawal. In most published cases AITP occurred during treatment; in fact, among 24 cases of AITP related to interferon-based antiviral treatment, only one occurred after discontinuation. Early diagnosis of AITP is a key factor in order to achieve an early interferon discontinuation; in the era of new direct antiviral agents those patients have to be considered for interferon-free treatment regimens. Prompt prescription of immuno-suppressant treatment (i.e., corticosteroids, immunoglobulin infusion and even rituximab for unresponsive cases) leads to favourable prognosis in most of cases. Physicians using interferon-based treatments should be aware that AITP can occur both during and after treatment, specially in the new era of interferon-free antiviral treatment. Finally, in the case of suspected AITP, presence of anti-platelet antibodies should be checked not only during treatment but also after discontinuation.
authors.affiliation: Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Arena
authors.affiliation: Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cecinato
authors.affiliation: Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lisotti
authors.affiliation: Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Buonfiglioli
authors.affiliation: Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Calvanese
authors.affiliation: Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Grande
authors.affiliation: Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Montagnani
authors.affiliation: Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Azzaroli
authors.affiliation: Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mazzella
keywords: Anti-platelet antibody; Autoimmune thrombocytopenia; Chronic hepatitis C; Pegylated interferon; Viral hepatitis