Pleural effusion associated with pegylated interferon alpha and ribavirin treatment for chronic hepatitis C

Simultaneous occurrence of pleural effusion and interstitial pneumonitis after treatment with pegylated interferon for hepatitis C virus infection

Combination of pegylated interferon and ribavirin has been the standard program for hepatitis C virus (HCV) infection. Pulmonary complications, although uncommon, have been reported in association with the use of interferon, and pleural effusion is rare. We report the second case of pleural effusion and interstitial pneumonitis in a patient treated with pegylated interferon and ribavirin for chronic HCV infection. The respiratory symptoms of our patient continued to progress even though the treatment with pegylated interferon had been withdrawn, but the symptoms improved dramatically following treatment with steroids.

Diagnosis and management of interstitial pneumonitis associated with interferon therapy for chronic hepatitis C

Interstitial pneumonitis (IP) is an uncommon pulmonary complication associated with interferon (IFN) therapy for chronic hepatitis C virus (HCV) infection. Pneumonitis can occur at any stage of HCV treatment, ranging from 2 to 48 wk, usually in the first 12 wk. Its most common symptoms are dyspnoea, dry cough, fever, fatigue, arthralgia or myalgia, and anorexia, which are reversible in most cases after cessation of IFN therapy with a mean subsequent recovery time of 7.5 wk. Bronchoalveolar lavage in combination with chest high resolution computed tomography has a high diagnostic value. Prompt discontinuation of medication is the cornerstone, and corticosteroid therapy may not be essential for patients with mild-moderate pulmonary functional impairment. The severity of pulmonary injury is associated with the rapid development of IP. We suggest that methylprednisolone pulse therapy followed by low dose prednisolone for a short term is necessary to minimize the risk of fatal pulmonary damage if signs of significant pulmonary toxicity occur in earlier stage. Clinicians should be aware of the potential pulmonary complication related to the drug, so that an early and opportune diagnosis can be made.