Ischemic colitis during interferon-ribavirin therapy for chronic hepatitis C： A case report

• Published in: World journal of gastroenterology : WJG Vol. 18; no. 31; pp. 4233 - 4236
• Main Authors: Baik, Su Jung, Kim, Tae Hun, Yoo, Kwon, Moon, Il Hwan, Cho, Min-Sun
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Co., Limited 21.08.2012
• Subjects: Abdominal Pain - etiology; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Case Report; Colitis, Ischemic - chemically induced; Colitis, Ischemic - complications; Colitis, Ischemic - diagnosis; Colonoscopy; Drug Therapy, Combination; Female; Gastrointestinal Hemorrhage - etiology; Hepatitis C, Chronic - drug therapy; Humans; Interferon-alpha - adverse effects; Interferon-alpha - therapeutic use; Middle Aged; Polyethylene Glycols - adverse effects; Polyethylene Glycols - therapeutic use; Recombinant Proteins - adverse effects; Recombinant Proteins - therapeutic use; Ribavirin - adverse effects; Ribavirin - therapeutic use; Withholding Treatment; 丙型肝炎; 利巴韦林; 干扰素α; 慢性; 治疗; 病例报告; 结肠炎; 缺血; Ischemia; Hepatitis C; Interferon
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v18.i31.4233

Ischemic colitis is a rare complication of interferon administration. Only 9 cases in 6 reports have been described to-date. This report describes a case of isch- emic colitis during pegylated interferon and ribavirin treatment for chronic hepatitis C, and includes a review of the relevant literature. A 48-year-old woman was treated with pegylated interferon ~-2a and ribavirin for chronic hepatitis C, genotype Ib. After 19 wk of treatment, the patient complained of severe afebrile abdominal pain with hematochezia. Vital signs were stable and serum white blood cell count was within the normal range. Abdominal computed tomography showed diffuse colonic wall thickening from the splenic flexure to the proximal sigmoid colon, which is the most vulnerable area for the development of ischemic colitis. Colonoscopy revealed an acute mucosal hyper- emic change, with edema and ulcerations extending from the proximal descending colon to the sigmoid colon. Colonic mucosal biopsy revealed acute exuda- tive colitis. Polymerase chain reaction and culture for Mycobacterium tuberculosis were negative and the cul- tures for cytomegalovirus, Salmonella and Shigella spe- cies were negative. After discontinuation of interferon and ribavirin therapy, abdominal pain and hematochezia subsided and, following colonoscopy showed improve- ment of the mucosal ulcerations. Ischemic colitis cases during interferon therapy in patients with chronic hepa- titis C reported so far have all involved the descending colon. Ischemic colitis is a rarely encountered complica- tion of interferon administration in patients with chronic hepatitis C and should be considered when a patient complains of abdominal pain and hematochezia.