Answer 5

To begin with : What is the problem ?

In spite of negative HCV PCR after interferon and Ribavirin treatment (implicating the absence of other injurious sources as evidenced during patient preparation for interferon treatment in a good hepatology centre and postulating disappearance of the hepatic injury source, i.e. HCV), there is still evidence of continuous hepatic injury and even decompensation (evidenced by ↑ liver enzymes and clinical manifestations of hepatic decompensation). So what is the source of hepatic injury ?

@ Letters from internal medicine residents:

-An Email from Dr.Magdi Nagiub and Dr.Abd El-Hamid Abd El-Razik :

"...Problem:

A chronic hepatitis C patient who received a course of interferon for 10 months with persistent elevated liver enzymes with markedly decreasing platelet count.

Discussion:

The patient with chronic hepatitis C can develop elevated liver enzymes as a sign of decompensation , also can develop thrombocytopenia as a sign  of hypersplenism or extrahepatic manifestation of hepatitis C but :

1-in this patient who received interferon therapy most probably these signs are due to interferon complication.

2-This patient may have caught another infection as hepatitis B .

3-Systemic infection as this patient most probably immunocompromized due to interferon therapy.

4-Development of HCC.

But finally  I recommend that the patient is to discontinue interferon therapy due to marked thrombocytopenia......" Letter ended and thanks for the compliment.

Notices regarding:

4-HCC : there is no evidence about this mentioned in the case presentation (like absence of focal lesions by ultrasonography) .

3-Also not likely due to the above cause. (always support your opinion with evidence from the case data)  

2-Theoritically accepted but practically not accepted.

1-A good reasoning but in what form of injury ?( is it due to direct toxicity from a drug, for instance?)

Thank you and keep going Dr.Magdi and Dr. Abd El-Hamid .

 

This is a case report !!

 

This is considered a case report of an unreported side effect  of combined interferon and Ribavirin as a treatment regimen of HCV infected patients.

Interferon is known to aggravate an existing autoimmune disease but the unusual ,as in this case , is to " initiate a new autoimmune process " .

As a solution to the mentioned problem above the explanation was the presence of "autoimmune hepatitis", evidenced by positive autoimmune profile that was negative during the preparation for the interferon therapy.

During the course of therapy there was not a logic search for hepatic decompensation cause or a clear explanation as treatment did not give what was meant by it , i.e. protection from hepatic injury and decompensation.

Now what is the proper action to take?

Logically it is imperative to stop the offending agent immediately.