title: Acute septic shock during pegylated-interferon and ribavirin therapy in a patient with chronic hepatitis C who underwent aortic graft replacement.
abstract: We report an autopsied case of a 59-year-old woman with acute septic shock from methicillin-resistant Staphylococcus aureus (MRSA) infection during combination therapy with pegylated-interferon-α-2b (PEG-IFNα-2b) and ribavirin. She underwent aortic graft replacement for the treatment of a dissecting aneurysm. We observed her latent infection closely for over a year following the operation. The clinical and laboratory examinations did not show any sign of infection. She then underwent PEG-IFNα-2b/ribavirin combination therapy. In her 17th week of therapy, she suddenly complained of high fever followed by a markedly rapid progression of sepsis and disseminated intravascular coagulation. She died of acute septic shock from MRSA infection on her fourth hospital day. Autopsy revealed abscess formation in the mediastinum around the artificial vessel graft. There was no obvious verruca on the internal surface of the replaced graft. Microscopic examination revealed numerous cocci along the thread in the suture of the graft. This clinical experience shows that combination therapy with PEG-IFNα-2b/ribavirin for the treatment of chronic hepatitis C should be given careful consideration when administered to patients who have undergone major vessel surgery, such as aortic graft replacement. Once the treatment has been started, infection should be monitored with particular care and frequent medical examinations.
authors.affiliation: Center for Physical and Mental Health, Mie University Graduate School of Medicine, Tsu, Mie, 514-8507, Japan. yoshinao@ab.mie-u.ac.jp.
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Kohta
authors.initials: K
authors.lastname: Nishihama
authors.affiliation: Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Miyachi
authors.affiliation: Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Mohoh
authors.initials: M
authors.lastname: Iwasa
authors.affiliation: Pathology Division, Mie University Hospital, Tsu, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Fukutome
authors.affiliation: Department of Pathologic Oncology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Taizo
authors.initials: T
authors.lastname: Shiraishi
authors.affiliation: Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Takei
keywords: Aortic graft replacement; Disseminated intravascular coagulation; Methicillin-resistant Staphylococcus aureus; Pegylated-interferon; Sepsis