Acute Exacerbation of Liver Disease Induced by Pegylated Interferon Alpha2a Treatment for Chronic Hepatitis C

A 66-year-old female was referred to a local clinic for the treatment of chronic hepatitis C. Her family physician started the administration of Peg-IFN alpha2a in combination with ribavirin in September, 2008. Three months after the commencement of the therapy, alopecia was noted, and it gradually worsened. She also complained of general fatigue. Since her alopecia and general fatigue continued to worsen, her family physician decided to discontinue the Peg-IFN plus ribavirin therapy in February, 2009. On April 5, the patient complained of severe general fatigue as well as fever, and she was referred to the local clinic again. Blood chemistry tests demonstrated that her AST level increased from 200 IU on April 5 to 1000 IU on April 9 but her HCV RNA level stayed at 4.1 logIU/mL. Based on the findings of an elevated IgG level (2244 mg), AST/ALT > 1.5, and weak positivity for anti-smooth muscle antibody (1:40), an autoimmune mechanism was considered as the etiology of her liver damage. Despite treatment with 60 ml of glycyrrhizin, 1 g of gabexate mesylate, and 500 mg of methylprednisolone, she died on April 23. Peg-IFN induced acute liver failure is quite rare, but clinicians should aware of this life-threatening side effect during and after interferon therapy.