title: Myasthenia Crisis Induced by Pegylated-Interferon in Patient With Chronic Hepatitis C: A Case Report.
abstract: Myasthenia gravis is occasionally associated with thymoma that needs surgical resection and may progress to severe respiratory failure. We experienced a rare case of myasthenia crisis during antiviral therapy for chronic hepatitis C, in whom mediastinal thymoma was discovered and successfully managed with surgical thymectomy and meticulous medical care.A 47-year-old-male patient complained of sudden diplopia 1 week after stopping 11-week administration of pegylated-interferon and ribavirin for chronic hepatitis C. Ophthalmologic examinations revealed ptosis on the right eyelid and restricted right eye movement. Myasthenia gravis was confirmed by positive repetitive nerve stimulation test and positive serum antiacetylcholine receptor antibody test, and mediastinal thymoma was found on chest CT scan. The ocular myasthenia gravis progressed to respiratory failure even after discontinuing antiviral treatment but eventually recovered with thymectomy, anticholinesterase administration, steroid pulse therapy, and prolonged ventilator care. We describe the clinical features of this life-threatening complication of interferon treatment along with previous myasthenia crisis cases by interferon for chronic hepatitis C.In patients with chronic hepatitis C who is going to receive interferon-based antiviral treatment, physicians need to keep in mind the potential life-threatening manifestations of myasthenia gravis before and during antiviral treatment especially when patients complain of muscular weakness and easy fatigability.
authors.affiliation: From the Healthcare Research Team (SJB), Health promotion Center, Gangnam Severance Hospital; Department of Gastroenterology (THK, HIK), Ewha Womans University School of Medicine; and College of Pharmacy (JYR), Ewha Womans University, Seoul, Republic of Korea.
authors.forename: Su Jung
authors.initials: SJ
authors.lastname: Baik
authors.forename: Tae Hun
authors.initials: TH
authors.lastname: Kim
authors.forename: Hye In
authors.initials: HI
authors.lastname: Kim
authors.forename: Jeong Yeon
authors.initials: JY
authors.lastname: Rhie
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000139:chemically induced*; D011092:Polyethylene Glycols; D012121:Respiration, Artificial; D012254:Ribavirin / Q000627:therapeutic use; D013945:Thymoma / Q000175:diagnosis / Q000601:surgery; D013953:Thymus Neoplasms / Q000175:diagnosis / Q000601:surgery
chemical_list: D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D002800:Cholinesterase Inhibitors; D016898:Interferon-alpha; D011092:Polyethylene Glycols; D012254:Ribavirin