The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Cryptococcal meningitis in a patient with chronic hepatitis C treated with pegylated-interferon and ribavirin

  • Lee, Tae-Hee (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Lee, Kee-Ook (Department of Neurology, Konyang University College of Medicine) ;
  • Kim, Yong-Seok (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Kim, Sun-Moon (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Huh, Kyu-Chan (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Choi, Young-Woo (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Kang, Young-Woo (Department of Internal Medicine, Konyang University College of Medicine)
  • Received : 2012.02.17
  • Accepted : 2012.08.06
  • Published : 2014.05.01
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Abstract

Various adverse events have been reported during combination therapy with pegylated (PEG)-interferon-$\alpha$ and ribavirin, although opportunistic infections, especially cryptococcal meningitis, are very rare. A 61-year-old woman complained of headaches and a fever during treatment of a chronic hepatitis C virus (HCV) infection. She had been treated for 7 months. Her headaches were refractory to analgesics, and she developed subtle nuchal rigidity. The cerebral spinal fluid (CSF) revealed a white blood cell count of $205/mm^3$, 51 mg/dL protein, 35 mg/dL glucose, and negative Cryptococcus antigen. The CSF culture resulted in no growth. Five days later, the CSF was positive for Cryptococcus antigen. We administered amphotericin B and flucytosine, followed by fluconazole. Approximately 2 months later, she was discharged. For the first time, we report a case of cryptococcal meningitis during the treatment of chronic HCV with PEG-interferon-$\alpha$ and ribavirin.

Keywords

References

  1. Kwon-Chung KJ, Sorrell TC, Dromer F, Fung E, Levitz SM. Cryptococcosis: clinical and biological aspects. Med Mycol 2000;38 Suppl 1:205-213. https://doi.org/10.1080/mmy.38.s1.205.213
  2. Netea MG, Brouwer AE, Hoogendoorn EH, et al. Two patients with cryptococcal meningitis and idiopathic CD4 lymphopenia: defective cytokine production and reversal by recombinant interferon-gamma therapy. Clin Infect Dis 2004;39:e83-e87. https://doi.org/10.1086/425121
  3. Vander T, Medvedovsky M, Hallevy C, Golzman G, Herishanu Y. Listeria monocytogenes meningitis in a patient with chronic hepatitis C infection, treated by interferon alfa and ribavirin. J Infect 2003;46:70-71. https://doi.org/10.1053/jinf.2002.1085
  4. Hadem J, Cornberg M, Hauptmann C, Suttmann U, Manns MP, Wedemeyer H. Pneumococcal meningitis during antiviral treatment with interferon and ribavirin in a splenectomized patient with chronic hepatitis C: do not miss vaccination before starting therapy. Z Gastroenterol 2008;46:880-882. https://doi.org/10.1055/s-2008-1027149
  5. Hoofnagle JH, Seeff LB. Peginterferon and ribavirin for chronic hepatitis C. N Engl J Med 2006;355:2444-2451. https://doi.org/10.1056/NEJMct061675
  6. Gutterman JU. Cytokine therapeutics: lessons from interferon alpha. Proc Natl Acad Sci U S A 1994;91:1198-1205. https://doi.org/10.1073/pnas.91.4.1198
  7. Patterson JL, Fernandez-Larsson R. Molecular mechanisms of action of ribavirin. Rev Infect Dis 1990;12:1139-1146. https://doi.org/10.1093/clinids/12.6.1139
  8. Erickson S, Matikainen S, Thyrell L, et al. Interferon- alpha inhibits Stat5 DNA-binding in IL-2 stimulated primary T-lymphocytes. Eur J Biochem 2002;269:29-37. https://doi.org/10.1046/j.0014-2956.2002.02626.x
  9. Byrnes AA, Ma X, Cuomo P, et al. Type I interferons and IL-12: convergence and cross-regulation among mediators of cellular immunity. Eur J Immunol 2001;31:2026-2034. https://doi.org/10.1002/1521-4141(200107)31:7<2026::AID-IMMU2026>3.0.CO;2-U
  10. Lombardi G, Dunne PJ, Scheel-Toellner D, et al. Type 1 IFN maintains the survival of anergic CD4+ T cells. J Immunol 2000;165:3782-3789. https://doi.org/10.4049/jimmunol.165.7.3782
  11. Hultgren C, Milich DR, Weiland O, Sallberg M. The antiviral compound ribavirin modulates the T helper (Th) 1/Th2 subset balance in hepatitis B and C virus-specific immune responses. J Gen Virol 1998;79:2381-2391. https://doi.org/10.1099/0022-1317-79-10-2381
  12. Shiffman ML, Verbeke SB, Kimball PM. Alpha interferon combined with ribavirin potentiates proliferative suppression but not cytokine production in mitogenically stimulated human lymphocytes. Antiviral Res 2000;48:91-99. https://doi.org/10.1016/S0166-3542(00)00120-0
  13. Fried MW. Side effects of therapy of hepatitis C and their management. Hepatology 2002;36(5 Suppl 1):S237-S244.
  14. Soza A, Everhart JE, Ghany MG, et al. Neutropenia during combination therapy of interferon alfa and ribavirin for chronic hepatitis C. Hepatology 2002;36:1273-1279. https://doi.org/10.1053/jhep.2002.36502
  15. Cooper CL, Al-Bedwawi S, Lee C, Garber G. Rate of infectious complications during interferon-based therapy for hepatitis C is not related to neutropenia. Clin Infect Dis 2006;42:1674-1678. https://doi.org/10.1086/504386
  16. Juarez-Navarro A, Vera-de-Leon L, Navarro JM, et al. Incidence and severity of infections according to the development of neutropenia during combined therapy with pegylated interferon-alpha2a plus ribavirin in chronic hepatitis C infection. Methods Find Exp Clin Pharmacol 2005;27:317-322. https://doi.org/10.1358/mf.2005.27.5.908646
  17. Puoti M, Babudieri S, Rezza G, et al. Use of pegylated interferons is associated with an increased incidence of infections during combination treatment of chronic hepatitis C: a side effect of pegylation? Antivir Ther 2004;9:627-630.
  18. Antonini MG, Babudieri S, Maida I, et al. Incidence of neutropenia and infections during combination treatment of chronic hepatitis C with pegylated interferon alfa-2a or alfa-2b plus ribavirin. Infection 2008;36:250-255. https://doi.org/10.1007/s15010-007-7132-6
  19. Bani-Sadr F, Goderel I, Lapidus N, et al. Risk factors for bacterial infections in HIV/hepatitis C virus-coinfected patients treated with interferon plus ribavirin. AIDS 2008;22:1385-1387. https://doi.org/10.1097/QAD.0b013e328305bd8d
  20. Shih CC, Chen YC, Chang SC, Luh KT, Hsieh WC. Cryptococcal meningitis in non-HIV-infected patients. QJM 2000;93:245-251. https://doi.org/10.1093/qjmed/93.4.245
  21. Kauffman CA. Cryptococcosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia: Saunders, 2008:2347-2349.

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