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Waltschew A. [Cutaneous sarcoidosis after treatment with interferon for hepatitis C: A not entirely rare but often overlooked reaction]. DER PATHOLOGE 2017; 37:184-6. [PMID: 26769217 DOI: 10.1007/s00292-015-0127-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Sarcoidosis (aka Boeck's sarcoid) is a granulomatous autoimmune disease of unknown etiology, which may affect the lungs and many other organs. A case of multifocal cutaneous sarcoidosis after treatment with pegylated interferon-alpha and ribavirin for chronic hepatitis C is demonstrated. Several related cases of this not entirely rare complication of immunotherapy have been reported in the literature.
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Affiliation(s)
- A Waltschew
- , Hammerstr. 3, 90482, Nürnberg, Deutschland.
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Coban H, Yahyaoglu M, Vatan MB. Concurrent acute interstitial pneumonia and pulmonary embolism during treatment with peginterferon alpha-2a and ribavirin in a patient with hepatitis C. Indian J Pharmacol 2015; 46:443-5. [PMID: 25097288 PMCID: PMC4118543 DOI: 10.4103/0253-7613.135962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/18/2013] [Accepted: 06/10/2014] [Indexed: 11/25/2022] Open
Abstract
The case presented is the first patient with concurrent acute interstitial pneumonia and pulmonary embolism associated with combined treatment of peginterferon and ribavirin for hepatitis C.
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Affiliation(s)
- Hikmet Coban
- Department of Chest Diseases, Sakarya University Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Mehmet Yahyaoglu
- Department of Enfection Diseases, Sakarya University Sakarya Training and Research Hospital, Sakarya, Turkey
| | - M Bülent Vatan
- Department of Cardiology, Sakarya University Sakarya Training and Research Hospital, Sakarya, Turkey
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Buss G, Cattin V, Spring P, Malinverni R, Gilliet M. Two cases of interferon-alpha-induced sarcoidosis Koebnerized along venous drainage lines: new pathogenic insights and review of the literature of interferon-induced sarcoidosis. Dermatology 2013; 226:289-97. [PMID: 23886768 DOI: 10.1159/000346244] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous disorder of unknown origin commonly affecting the lung, the lymphoid system and the skin. We report here two cases of cutaneous sarcoidosis in two former intravenous drug users following interferon (IFN)-α and ribavirin therapy for chronic hepatitis C. Both patients developed skin sarcoidosis along venous drainage lines of both forearms, coinciding with the areas of prior drug injections. The unique distribution of the skin lesions suggests that tissue damage induced by repeated percutaneous drug injections represents a trigger for the local skin manifestation of sarcoidosis. Interestingly, skin damage was recently found to induce the local expression IFN-α, a well-known trigger of sarcoidosis in predisposed individuals. Here we review the literature on sarcoidosis elicited in the context of IFN-α therapy and propose a new link between the endogenous expression of IFN-α and the induction of disease manifestations in injured skin.
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Affiliation(s)
- G Buss
- Division of Immunology and Allergology, University of Lausanne, Lausanne, Switzerland
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Assenova M, Sacko A, Cadranel JF, Logak M. [Peripheral neurosarcoidosis and chronic C hepatitis: Responsibility of antiviral therapies]. Rev Neurol (Paris) 2012; 168:874-6. [PMID: 22705231 DOI: 10.1016/j.neurol.2011.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 05/04/2009] [Accepted: 11/28/2011] [Indexed: 11/29/2022]
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Levitsky J, Fiel MI, Norvell JP, Wang E, Watt KD, Curry MP, Tewani S, McCashland TM, Hoteit MA, Shaked A, Saab S, Chi AC, Tien A, Schiano TD. Risk for immune-mediated graft dysfunction in liver transplant recipients with recurrent HCV infection treated with pegylated interferon. Gastroenterology 2012; 142:1132-1139.e1. [PMID: 22285805 DOI: 10.1053/j.gastro.2012.01.030] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 01/09/2012] [Accepted: 01/15/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Patients with recurrent hepatitis C virus infection treated with pegylated interferon (PEG) after liver transplantation can develop severe immune-mediated graft dysfunction (IGD) characterized by plasma cell hepatitis or rejection. METHODS We conducted a multicenter case-control study of 52 liver transplant recipients with hepatitis C to assess the incidence of, risk factors for, and outcomes of PEG-IGD. Data from each patient were compared with those from 2 matched patients who did not develop PEG-IGD (n = 104). We performed a multivariate analysis of risk factors and analyzed treatment and outcomes of graft dysfunction subtypes. RESULTS Overall incidence of PEG-IGD during a 10-year study period was 7.2%. Risk factors included no prior PEG therapy (odds ratio = 5.3; P < .0001), therapy with PEGα-2a (odds ratio = 4.7; P = .03), and immune features (mainly plasma cell hepatitis) on pre-PEG therapy liver biopsies (odds ratio = 3.9; P = .005). The PEG-IGD group had lower long-term patient (61.5% vs 91.3% of controls) and graft (38.5% vs 85.6% of controls) survival and higher rates of retransplantation (34.6% vs 6.7% of controls) (all, P < .0001), without increases in sustained virologic response. Variables associated with increased mortality included acute rejection as the PEG-IGD sub-type (hazard ratio [HR] = 2.4; P = .002), a high level of alkaline phosphatase at PEG initiation (HR = 1.003; P = .005), and lack of a sustained virologic response (HR = 3.3; P = .04). Variables associated with graft failure included a high level of alkaline phosphatase at PEG initiation (HR = 1.002; P = .04) and lack of a sustained virologic response (HR = 2.1; P = .04). CONCLUSIONS PEG-IGD has high morbidity and mortality and is not associated with increased rates of virologic response. It is important to avoid PEG therapy in liver transplant recipients with specific clinical, biochemical, and histologic risk factors for PEG-IGD.
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Affiliation(s)
- Josh Levitsky
- Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois 60611, USA.
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López V, Molina I, Monteagudo C, Jordá E. Cutaneous sarcoidosis developing after treatment with pegylated interferon and ribavirin: a new case and review of the literature. Int J Dermatol 2011; 50:287-91. [DOI: 10.1111/j.1365-4632.2010.04728.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gayet AR, Plaisance P, Bergmann JF, Mouly S. Development of sarcoidosis following completion of treatment for hepatitis C with pegylated interferon-{alpha}2a and ribavirin: a case report and literature review. Clin Med Res 2010; 8:163-7. [PMID: 20852086 PMCID: PMC3006563 DOI: 10.3121/cmr.2010.886] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sarcoidosis is a chronic inflammatory multisystem disease of unknown etiology. We report on a woman, aged 57 years, presenting with typical sarcoidosis occurring two months after completion of a six-month course of interferon-α and ribavirin for chronic hepatitis C virus infection. The current observation is interesting with regard to the time elapsed between the occurrence of symptoms and antiviral treatment withdrawal, and spontaneous recovery after ten months of follow-up. Pathophysiological mechanisms involved in the development of antiviral therapy-induced sarcoidosis are discussed.
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Affiliation(s)
- Albéric-Rembrandt Gayet
- Emergency Department, Assistance Publique-Hôpitaux de Paris, Lariboisière Hospital, Paris, France.
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9
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Subcutaneous Sarcoidosis during Pegylated Interferon Alfa and Ribavirin Treatment for Chronic Hepatitis C. Dermatol Res Pract 2010; 2010:230417. [PMID: 20585599 PMCID: PMC2879954 DOI: 10.1155/2010/230417] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 03/07/2010] [Indexed: 01/04/2023] Open
Abstract
Interferon is used to treat hepatitis C virus infection and its cutaneous side effects are well known. Recently, interferon-induced sarcoidosis has been reported. We report a new case of sarcoidosis during pegylated interferon alfa and ribavirin treatment with an unusual presentation in a woman with previous episodes of erythema nodusum and nodular vasculitis related to HCV.
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Tsai MC, Lin MC, Hung CH. Successful antiviral and antituberculosis treatment with pegylated interferon-alfa and ribavirin in a chronic hepatitis C patient with pulmonary tuberculosis. J Formos Med Assoc 2010; 108:746-50. [PMID: 19773215 DOI: 10.1016/s0929-6646(09)60400-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Pulmonary tuberculosis is a rare side effect of antiviral treatment for chronic hepatitis C. We present the case of 55-year-old woman with chronic hepatitis C, who developed pulmonary tuberculosis after receiving 8 weeks of peginterferon alfa-2a plus ribavirin therapy. Antituberculous treatment was started and antiviral agents were given continually at adjusted doses. Her symptoms of cough with blood-tinged sputum improved 1 month after antituberculous therapy. Treatment for hepatitis C and pulmonary tuberculosis were completed after 6 months. At 6 months after antiviral therapy, a sustained virological response was achieved and follow-up chest radiography showed a marked regressive change. This is believed to be the first case report of complete remission from hepatitis C and pulmonary tuberculosis treated concurrently with antiviral and antituberculous agents.
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Affiliation(s)
- Ming-Chao Tsai
- Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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11
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Pneumonitis as a consequence of (peg)interferon-ribavirin combination therapy for hepatitis C: a review of the literature. Dig Dis Sci 2010; 55:579-85. [PMID: 19399621 PMCID: PMC2822957 DOI: 10.1007/s10620-009-0797-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 03/17/2009] [Indexed: 01/13/2023]
Abstract
Combination of peginterferon and ribavirin is the current therapy for chronic hepatitis C infection (HCV). Interstitial pneumonitis is a rare side-effect of HCV therapy and is an important cause of dose reduction or discontinuation, impairing success of antiviral therapy. We performed a review of the literature in order to present diagnostic modalities and possible treatments for pneumonitis and to offer guidelines. We searched for cases where pneumonitis as a side-effect of HCV treatment was documented. First we performed a literature search via PubMed and Web of Science interface and second we searched three drug toxicity databases. We systematically analyzed all case reports with respect to clinical manifestations, type of treatment, and outcome. A literature search revealed 19 articles, containing 25 case descriptions, while we traced 33 cases from the drug toxicity databases. Pneumonitis presented with any of the combination of fever, dyspnea, and cough and can arise with any type of (conventional or pegylated) interferon. Mortality secondary to pneumonitis was seen in 7% of cases, exclusively with peginterferon alpha-2b. In most cases therapy was discontinued and steroids were started. Interferon-induced pneumonitis during HCV treatment is a severe complication and should be recognized in order to prevent further pulmonary damage and/or death.
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Martins EV, Gaburri AK, Gaburri D, Sementilli A. Cutaneous Sarcoidosis: An Uncommon Side Effect of Pegylated Interferon and Ribavirin Use for Chronic Hepatitis C. Case Rep Gastroenterol 2009; 3:366-371. [PMID: 21103255 PMCID: PMC2988931 DOI: 10.1159/000251664] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The treatment of chronic hepatitis C (CHC) has evolved in the past 15 years and combination of pegylated interferon plus ribavirin is its current standard therapy. However, several side effects are commonly observed and frequently lead to transient or definitive interruption of treatment. Although sarcoidosis in its systemic or cutaneous form is a very rare side effect in such circumstances, some cases have been reported even with conventional interferon. This brief review of the literature and description of a case of sarcoidosis occurring in a tattoo and a scar patient's face, during treatment with pegylated interferon alpha-2b plus ribavirin, is an educative report directed in special to dermatologists. The lesion improved after drug interruption and recurred after retreatment with pegylated interferon alpha-2a. We conclude that this side effect must call the attention of doctors to seek for the diagnosis and therapy as soon as possible in such circumstances. No differences were noticed neither with alpha-2a nor alpha-2b pegylated interferon employment.
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Affiliation(s)
- Elson Vidal Martins
- Department of Gastroenterology and Hepatology, Metropolitan University of Santos, Santos, Brazil
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Fantini F, Padalino C, Gualdi G, Monari P, Giannetti A. Cutaneous lesions as initial signs of interferon α-induced sarcoidosis: report of three new cases and review of the literature. Dermatol Ther 2009; 22 Suppl 1:S1-7. [DOI: 10.1111/j.1529-8019.2009.01263.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Carmen Gota
- The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44118, USA
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Adla M, Downey KK, Ahmad J. Hepatic sarcoidosis associated with pegylated interferon alfa therapy for chronic hepatitis C: case report and review of literature. Dig Dis Sci 2008; 53:2810-2. [PMID: 18320314 DOI: 10.1007/s10620-008-0209-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 01/21/2008] [Indexed: 12/26/2022]
Affiliation(s)
- Mahathi Adla
- Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Abstract
Sarcoidosis continues to be a disease of research interest because of its complicated immune mechanisms and elusive etiology. So far, it has been established that granulomatous inflammation in sarcoidosis is predominantly a T-helper 1 immune response mediated by a complex network of lymphocytes, macrophages, and cytokines. The cause of progression to a chronic and potentially fibrotic form is unclear but may involve loss of apoptotic mechanisms, loss of regulatory response, or a persistent antigen that cannot be cleared. Recent genomic and proteomic technology has emphasized the importance of host susceptibility and gene-environment interaction in the expression of the disease.
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Affiliation(s)
- Alicia K Gerke
- Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Ferreira CN, Barjas ER, Correia LA, Tavares L, Ferreira C, Serejo FL, de Moura MC, Monteiro E. Generalized peripheral lymphadenopathy in a patient treated for chronic HCV infection. ACTA ACUST UNITED AC 2008; 5:469-74. [DOI: 10.1038/ncpgasthep1176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Accepted: 04/28/2008] [Indexed: 11/09/2022]
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Yan KKL, Dinihan I, Freiman J, Zekry A. Sarcoidosis presenting with granulomatous uveitis induced by pegylated interferon and ribavirin therapy for Hepatitis C. Intern Med J 2008; 38:207-10. [PMID: 18290816 DOI: 10.1111/j.1445-5994.2007.01625.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Sarcoidosis is a systemic granulomatous disease that is triggered by an autoimmune process, and is now a well recognized but uncommon complication of antiviral therapy for Hepatitis C virus (HCV) infection, likely related to its immunomodulatory effects. The clinical presentation of HCV related sarcoidosis is as varied as systemic sarcoidosis, but ocular presentation alone has not been reported previously. We present a 23 year-old female who developed visual disturbances due to ocular sarcoidosis during the course of antiviral therapy for chronic HCV infection. Our case presentation is then followed by a review of the literature on the topic. We aim to stress the importance of screening for eye problems in following HCV patients undergoing antiviral therapy, and raise clinicians' awareness of sarcoidosis as a possible cause for eye problems even in the absence of respiratory complaints.
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Affiliation(s)
- K K L Yan
- Department of Gastroenterology, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia
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Clinical Adverse Effects of Cytokines on the Immune System. METHODS IN PHARMACOLOGY AND TOXICOLOGY 2007. [DOI: 10.1007/978-1-59745-350-9_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
Rheumatologists are increasingly asked to see patients with hepatitis C who exhibit a variety of clinical and serologic features that mimic systemic rheumatic disease. Treatment with interferons, now the standard of care, can precipitate a variety of inflammatory conditions, including sarcoidosis. We present a case of a 59-year-old former intravenous drug user who developed systemic sarcoidosis while receiving interferon alpha and ribavirin for the treatment of chronic hepatitis C. Because interferons are increasingly prescribed by specialists in a variety of disciplines, rheumatologists should be aware of their potential to induce sarcoidosis as well as various autoimmune diseases.
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Goldberg HJ, Fiedler D, Webb A, Jagirdar J, Hoyumpa AM, Peters J. Sarcoidosis after treatment with interferon-alpha: a case series and review of the literature. Respir Med 2006; 100:2063-8. [PMID: 16675213 DOI: 10.1016/j.rmed.2006.03.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 03/02/2006] [Accepted: 03/04/2006] [Indexed: 01/30/2023]
Abstract
Recombinant interferon-alpha (rINF-alpha) is an immunomodulator used in the treatment of various conditions, including viral infections and malignancies. The use of rINF-alpha has been associated with the development of sarcoidosis in recent case reports. In this series, we report the incidence of sarcoidosis in recipients of rINF-alpha for hepatitis C viral (HCV) infection at our institution. We also review the 57 additional cases of sarcoidosis associated with rINF-alpha described in the literature, including clinical presentation, radiographic findings, management, and outcomes, and discuss the potential mechanisms by which rINF-alpha may lead to the development of sarcoidosis.
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Affiliation(s)
- Hilary J Goldberg
- Brigham and Womens' Hospital, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harvard University School of Medicine, PBB Clinics-3, 75 Francis St., Boston, MA 02115, USA.
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Benali S, Boustière C, Castellani P, Cesari C, Jullien M, Lecomte L, Lebars O, Lambot G, Loyer R, Masseboeuf A, Perrier H, Oules V, Bourlière M. Sarcoïdose chez deux malades traités par interféron pégylé pour une hépatite chronique C. ACTA ACUST UNITED AC 2006; 30:615-9. [PMID: 16733389 DOI: 10.1016/s0399-8320(06)73238-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
One side effect of the immunomodulatory effect of interferon is the possible triggering or exacerbation of systemic or cutaneous sarcoidosis. We report two new cases and offer an exhaustive review of the literature. A 39-year-old man with type C chronic active hepatitis developed new respiratory symptoms and pulmonary infiltrates with hilar and mediastinal adenopathy after 7 months of treatment with pegylated interferon. The evolution was favourable after stopping treatment. The second patient developed cutaneous lesions after 6 months of treatment. Resolution occurred after the discontinuation of the treatment. In these two cases ribavirin was stopped before the first signs of sarcoidosis.
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Affiliation(s)
- Souad Benali
- Service d'Hépato-Gastroentérologie, Hôpital Saint Joseph, Marseille
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Salgado Ordóñez F, Manteca González R, Palacios Rodríguez S, Godoy Guerrero M. [Patient with HCV chronic hepatitis who has subcutaneous nodules after finishing treatment with pegylated interferon]. Rev Clin Esp 2006; 205:621-2. [PMID: 16527184 DOI: 10.1016/s0014-2565(05)72656-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Interferons (IFNs) are widely used for the treatment of various medical diseases. They have marked immunomodulatory effects, and many reports have been published associating IFN therapy with the induction of autoimmune phenomena and other disorders of immune regulation such as sarcoidosis. The clinical presentation of IFN-induced sarcoidosis (IIS) is insidious and can be confused with common constitutional side effects of these drugs. The age of onset of IIS is later than that of naturally occurring sarcoidosis. The most common organs involved are the lungs and skin. In the majority of cases, IIS follows a benign course. As we show in an illustrative case report, complete resolution after discontinuation of IFN therapy can be expected. This review summarises 65 cases of IIS reported in the literature and highlights the pathophysiology, clinical features, diagnostic modalities and therapeutic options for this increasingly recognised phenomenon.
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Affiliation(s)
- S Alazemi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Miami School of Medicine, Miami, FL 33101, USA
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Hirano A, Kataoka M, Nakata Y, Takeda K, Kamao T, Hiramatsu J, Kimura G, Tanimoto Y, Kanehiro A, Tanimoto M. Sarcoidosis occurring after interferon-alpha therapy for chronic hepatitis C: Report of two cases. Respirology 2005; 10:529-34. [PMID: 16135180 DOI: 10.1111/j.1440-1843.2005.00745.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report two patients who were diagnosed with sarcoidosis after receiving interferon (IFN)-alpha therapy for chronic hepatitis C, and conduct a review the relevant literature. The first patient was a 52-year-old female who developed multiple subcutaneous nodules 2 months after finishing IFN-alpha therapy. A skin biopsy from subcutaneous nodules on the right elbow joint revealed sarcoid granulomata. These lesions resolved spontaneously 4 months later. The second patient, a 57-year-old male, developed bilateral hilar and mediastinal lymph node enlargement 2 years after finishing IFN-alpha 2a therapy. A transbronchial lung biopsy demonstrated sarcoid granulomata. In addition, he had uveitis and left ulnar nerve involvement. His eye and nerve involvement gradually improved over 20 months. It is feasible that IFN therapy has been a trigger for sarcoidosis in these patients.
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Affiliation(s)
- Atsushi Hirano
- Department of Internal Medicine II, Okayama University Medical School, Okayama, Japan.
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Abstract
Recombinant interferon-alpha (IFN-alpha) is being increasingly used in the treatment of chronic hepatitis C. It has been recently recognized that IFN-alpha can induce the development of sarcoidosis, presumably through its ability to stimulate the TH1 immune response. IFN-associated sarcoidosis is histologically similar to de novo sarcoidosis and is characterized by tightly compact epithelioid non-necrotizing granulomas. IFN-induced sarcoidosis may be unsuspected clinically, as the most common side effects of IFN-alpha simulate the symptoms of sarcoidosis. It is therefore important for pathologists to be aware of this association and encourage clinicians to carefully review the medication history in cases of pulmonary non-necrotizing granulomatous inflammation where there is a history of hepatitis C, as discontinuation of IFN-alpha can ameliorate the symptoms of sarcoidosis.
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Affiliation(s)
- Kelly J Butnor
- Department of Pathology, University of Vermont, Burlington, VT, USA.
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Abstract
Since the first description more than a century ago, intensive research continues to focus on sarcoidosis. Based on our current knowledge, sarcoidosis can be considered as an immune syndrome resulting from a variable combination of predisposing genetic, ethnic, and environmental factors. Over the last few years, several teams have proposed a link between certain genetic polymorphisms, particularly of the HLA system, and the risk of development or progression of sarcoidosis. Other pathogenic mechanisms involved in the formation of the sarcoid granuloma are becoming more clear and have led to the development of new therapeutic approaches such as anti-TNF currently being evaluated in multicentric trials.
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Affiliation(s)
- Abdellatif Tazi
- Service de Pneumologie, Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris Cedex 10.
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Tsiodras S, Drimala P, Stavreas N, Dachlythras M, Alamani AM, Naoum G. Uterine Sarcoidosis Potentially Associated With Interferon-α Use for Chronic Hepatitis C Infection. Obstet Gynecol 2005; 105:1198-201. [PMID: 15863580 DOI: 10.1097/01.aog.0000157764.44292.aa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A regimen including interferon-alpha has become the standard of care in the treatment of chronic hepatitis C over the last decade. One rare adverse effect associated with the use of interferon-alpha is a granulomatous pulmonary reaction. CASE A unique case of uterine sarcoidosis associated with the use of interferon-alpha for chronic hepatitis C infection is presented. CONCLUSION Gynecologists should be aware of a potential association between interferon-alpha therapy and granulomatous reactions occurring not only in the lung but also in the female genital tract.
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Ramos-Casals M, Mañá J, Nardi N, Brito-Zerón P, Xaubet A, Sánchez-Tapias JM, Cervera R, Font J. Sarcoidosis in patients with chronic hepatitis C virus infection: analysis of 68 cases. Medicine (Baltimore) 2005; 84:69-80. [PMID: 15758836 DOI: 10.1097/01.md.0000157577.69729.e6] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We describe the clinical characteristics, the patterns of association, and the role of antiviral therapies in patients with sarcoidosis associated with chronic hepatitis C virus (HCV) infection. Sixty-eight patients were included in the current study, 56 cases identified in the literature search plus 12 unpublished cases from our department. In 50 HCV patients, sarcoidosis appeared after starting antiviral therapy. Antiviral therapy associated with triggered sarcoidosis consisted of alpha-interferon monotherapy in 20 cases and combined therapy with alpha-interferon and ribavirin in 30. Sarcoidosis appeared during the first 6 months after starting therapy in 66% of patients. The clinical picture of sarcoidosis included predominantly pulmonary disease in 38 (76%) patients and cutaneous sarcoidosis in 30 (60%). Antiviral therapy was discontinued in 60% of patients and continued or adjusted in 14%, while sarcoidosis appeared after completed therapy in the remaining cases. Specific therapy for sarcoidosis was started in only 21 patients, mainly with oral corticosteroids. The outcome of patients was detailed in 46 cases: remission or improvement was observed in 38/46 (83%) patients, stabilization of sarcoidosis in 5/46 (11%), and reactivation of sarcoidosis after an initial improvement in 3/46 (6%). Finally, 18 treatment-naive HCV patients presented sarcoidosis, with 14/18 (87%) patients presenting with pulmonary involvement and 8/18 (44%) with cutaneous involvement. In summary, sarcoidosis may be observed in HCV patients in 2 different situations: triggered by antiviral therapy (in 75% of cases) and unrelated to treatment. Sarcoidosis during antiviral therapy may present mainly as cutaneous or pulmonary disease, with a benign, uncomplicated evolution in more than 85% of cases. However, more complicated cases are observed, especially in HCV patients with preexisting sarcoidosis and/or with previous antiviral treatment. Clinicians should be aware of the possibility that sarcoidosis may initially manifest or be reactivated during or shortly after treatment with antiviral therapy in patients with chronic HCV infection.
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Affiliation(s)
- Manuel Ramos-Casals
- From Departments of Autoimmune Diseases (MR-C, NN, PB-Z, RC, JF), Pneumology (AX), and Liver Unit (JMS-T), Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona and Department of Internal Medicine (JM), Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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Midturi J, Sierra-Hoffman M, Hurley D, Winn R, Beissner R, Carpenter J. Spectrum of pulmonary toxicity associated with the use of interferon therapy for hepatitis C: case report and review of the literature. Clin Infect Dis 2004; 39:1724-9. [PMID: 15578378 DOI: 10.1086/425746] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2004] [Accepted: 08/02/2004] [Indexed: 11/03/2022] Open
Abstract
Hepatitis C is one of the leading causes of liver disease in the United States, and current recommendations for its treatment include the use of interferon (IFN). Pulmonary side effects, although uncommon, have been reported in association with the use of IFN. We report a case of interstitial granulomatous pneumonitis that occurred after therapy with IFN and ribavirin, and we review the literature concerning this entity and other forms of IFN-associated pulmonary toxicity in patients with hepatitis C. The purpose of the present study is to increase awareness of the unusually wide spectrum of pulmonary toxicities associated with the use of IFN and ribavirin, with the anticipation that IFN will be used more frequently in the future for the treatment of hepatitis C.
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Affiliation(s)
- John Midturi
- Department of Internal Medicine, Division of Infectious Disease, Scott & White Memorial Hospital and Clinic, Temple, Texas 76508, USA.
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Camus P, Bonniaud P, Fanton A, Camus C, Baudaun N, Foucher P. Drug-induced and iatrogenic infiltrative lung disease. Clin Chest Med 2004; 25:479-519, vi. [PMID: 15331188 DOI: 10.1016/j.ccm.2004.05.006] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
At present more than 350 drugs are known to cause injury of the lung parenchyma,upper and lower airways, pulmonary circulation, pleura, mediastinum, lymph nodes,and neuromuscular system. Infiltrative lung disease (ILD) is the most common pattern of drug-induced injury. This article, which is clinically oriented rather than drug oriented, reviews the patterns of ILD produced by therapeutic drugs and radiation therapy.
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Affiliation(s)
- Philippe Camus
- Department of Pulmonary Disease and Intensive Care, Hôpital du Bocage, Faculté de Médecine at Université de Bourgogne, 2 Bd Marechal de Lattre de Tasigny, 21034 Dijon Cedex, France.
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Abstract
PURPOSE OF REVIEW Interferon therapy can induce or exacerbate sarcoidosis. With the increasing use of interferons it is highly likely that more cases of sarcoidosis will be encountered by clinicians. We describe three unusual cases of interferon-induced sarcoidosis and review the most recent relevant literature on this subject. RECENT FINDINGS Interferons, on account of their antiviral antigrowth and immunomodulatory effects, are used to treat various internal and dermatological diseases. Exogenously administered interferons stimulate the Th-1 response, which plays a major role in granuloma formation. In most of the patients with interferon-induced sarcoidosis, the disease subsides when interferon is discontinued. Occasionally, treatment with corticosteroids may become necessary. SUMMARY Interferon therapy can induce or exacerbate sarcoidosis, the disease disappears when interferon is discontinued, sometimes treatment with corticosteroids is required.
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Affiliation(s)
- Kamel Marzouk
- Division of Pulmonary and Critical Care Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California 90033, USA.
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Camus P, Fanton A, Bonniaud P, Camus C, Foucher P. Interstitial Lung Disease Induced by Drugs and Radiation. Respiration 2004; 71:301-26. [PMID: 15316202 DOI: 10.1159/000079633] [Citation(s) in RCA: 284] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
An ever-increasing number of drugs can reproduce variegated patterns of naturally occurring interstitial lung disease (ILD), including most forms of interstitial pneumonias, alveolar involvement and, rarely, vasculitis. Drugs in one therapeutic class may collectively produce the same pattern of involvement. A few drugs can produce more than one pattern of ILD. The diagnosis of drug-induced ILD (DI-ILD) essentially rests on the temporal association between exposure to the drug and the development of pulmonary infiltrates. The histopathological features of DI-ILD are generally consistent, rather than suggestive or specific to the drug etiology. Thus, the diagnosis of DI-ILD is mainly made by the meticulous exclusion of all other possible causes. Drug dechallenge produces measurable improvement in symptoms and imaging in the majority of patients, whereas corticosteroid therapy is indicated if symptoms are present or drug dechallenge is without an effect. Rechallenge is justified in a minority of patients, and is discouraged for diagnostic purposes only. Pneumotox (www.pneumotox.com) provides updated information on drug-induced respiratory disease.
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Affiliation(s)
- Philippe Camus
- Department of Pulmonary and Intensive Care, University Medical Center Le Bocage and Medical School, Université de Bourgogne, Dijon, France.
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Abstract
PURPOSE OF REVIEW This review emphasizes the importance of the rheumatological signs and symptoms in the presentation of sarcoidosis. Often the presence of musculoskeletal findings may lead to the diagnosis of the disease and the institution of the appropriate treatment. RECENT FINDINGS There have been significant advances in the treatment of sarcoidosis with the use of biologic agents for recalcitrant and severe manifestations of the disease as well as some new data regarding pathogenetics and new applications of diagnostic imaging studies such as positron emission tomography scanning. SUMMARY Although pulmonary disease is the most frequent manifestation of sarcoidosis, musculoskeletal symptoms are not only common, but may be the initial presentation of this systemic inflammatory process and could mimic other arthritic and autoimmune disorders. This article focuses on the rheumatological aspects of sarcoidosis and includes a review of the most recent literature, which shows new data on the diagnosis, pathogenesis, and treatment of this condition.
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Affiliation(s)
- Andy Abril
- Division of Rheumatology, Mayo Clinic, Jacksonville, Florida 32224, USA.
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Ozaras R, Tahan V, Mert A, Uraz S, Kanat M, Tabak F, Avsar E, Ozbay G, Celikel CA, Tozun N, Senturk H. The prevalence of hepatic granulomas in chronic hepatitis C. J Clin Gastroenterol 2004; 38:449-52. [PMID: 15100526 DOI: 10.1097/00004836-200405000-00011] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Hepatic granulomas are not usual findings in chronic hepatitis C. A few studies addressing the frequency of hepatic granulomas in chronic hepatitis C reported it as less than 10%. The presence of it has been suggested to predict a favorable response to interferon treatment. Also, case reports described the development of hepatic granulomas after interferon treatment. In this study, we aimed to detect the prevalence of hepatic granulomas in chronic hepatitis C and to identify the causes other than chronic hepatitis C, if present, to search whether there is an association between the presence of granuloma and response to interferon treatment and also to see whether interferon leads to the formation of hepatic granulomas. METHODS Patients from 3 university clinics were included. All patients with chronic hepatitis C were determined. All patients with hepatic granulomas were screened for the other causes of hepatic granuloma with tuberculin skin test, chest X-ray and computed tomography, Venereal Disease Research Laboratory, and Brucella agglutination tests. The histologic assessment of liver biopsies was done by the same pathologist in each center. RESULTS A total of 725 liver biopsies of 605 patients with chronic hepatitis C were screened. In 8 patients, hepatic granulomas were detected in the initial liver biopsies. Four patients had repeat biopsies, and all had hepatic granulomas again. The prevalence of hepatic granulomas in patients with chronic hepatitis C was calculated as 1.3% (8 of 605) in reference to patient population. Presence or absence of hepatic granulomas was seemingly stable. All patients with hepatic granulomas had negative results of tuberculin skin test, Venereal Disease Research Laboratory, chest X-ray and computed tomography, and Brucella agglutination tests. All repeat biopsies were obtained after interferon (+/- ribavirin) in varying doses and duration. Four of 8 patients with hepatic granulomas were found to respond interferon therapy. No patient was found to develop hepatic granulomas after interferon therapy. CONCLUSION Hepatic granulomas are a rare finding in HCV infection. The presence of it does not seem to predict the response to interferon therapy. The development of hepatic granulomas during interferon therapy is not usual.
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Affiliation(s)
- Resat Ozaras
- Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
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36
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Tsimpoukas F, Goritsas C, Papadopoulos N, Trigidou R, Ferti A. Sarcoidosis in untreated chronic hepatitis C virus infection. Scand J Gastroenterol 2004; 39:401-3. [PMID: 15125477 DOI: 10.1080/00365520410004677] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Chronic hepatitis C has been implicated in the pathogenesis of sarcoidosis in several cases of patients treated with interferon-alpha. On the other hand, only in a few cases previously has a possible link between sarcoidosis and untreated chronic hepatitis C virus infection been demonstrated. We report on a patient with chronic hepatitis C who developed cutaneous sarcoidosis without prior interferon-alpha treatment. We hypothesize that viral persistence seen in chronic hepatitis C virus infection might be one of the potential factors that trigger cellular immune response in granulomatous reactions as seen in sarcoidosis, in genetically predisposed patients.
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Affiliation(s)
- F Tsimpoukas
- Dept. of Internal Medicine, Sotiria General Hospital of Athens, Athens, Greece.
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Fuhrmann V, Kramer L, Bauer E, Laferl H, Tucek G, Dekan G, Schenk P. Severe interstitial pneumonitis secondary to pegylated interferon alpha-2b and ribavirin treatment of hepatitis C infection. Dig Dis Sci 2004; 49:1966-70. [PMID: 15628735 PMCID: PMC7101913 DOI: 10.1007/s10620-004-9602-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Valentin Fuhrmann
- Department of Internal Medicine 4, Intensive Care Unit, General Hospital and University of Vienna, Vienna, Austria
| | - Ludwig Kramer
- Department of Internal Medicine 4, Intensive Care Unit, General Hospital and University of Vienna, Vienna, Austria
| | - Edith Bauer
- Department of Internal Medicine 4, Intensive Care Unit, General Hospital and University of Vienna, Vienna, Austria
| | - Hermann Laferl
- Department of Internal Medicine 4, Kaiser Franz Josef Spital, Vienna Austria
| | - Gerhard Tucek
- Department of Pathology, Kaiser Franz Josef Spital, Vienna Austria
| | - Gerhard Dekan
- Department of Pathology, General Hospital and University of Vienna, Austria
| | - Peter Schenk
- Department of Internal Medicine 4, Intensive Care Unit, General Hospital and University of Vienna, Vienna, Austria
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