Autoimmunhepatitis und membranöse Glomerulonephritis unter Immuntherapie einer chronischen Hepatitis C
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Autoimmunhepatitis und membranöse Glomerulonephritis unter Immuntherapie einer chronischen Hepatitis C. / Paparoupa, Maria; Huy Ho, Ngoc Ahn; Schuppert, Frank.
in: DEUT MED WOCHENSCHR, Jahrgang 141, Nr. 10, 05.2016, S. 709-11.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Autoimmunhepatitis und membranöse Glomerulonephritis unter Immuntherapie einer chronischen Hepatitis C
AU - Paparoupa, Maria
AU - Huy Ho, Ngoc Ahn
AU - Schuppert, Frank
N1 - © Georg Thieme Verlag KG Stuttgart · New York.
PY - 2016/5
Y1 - 2016/5
N2 - A 63-year-old patient is evaluated for an unclear weight loss with general malaise and fatigue for several months. Serological examination reveales the first diagnosis of a hepatitis-C-virus-genotype-1b-infection with an initial viral load of 980 000 IU / ml. The duration of the infection is suggested to be more than 6 months. Because of the initially elevated anti-nuclear-antibodies (ANA) the diagnosis of an autoimmune hepatitis needs to be excluded. All other liver related autoantibodies and the immunoglobulins (Ig) IgG, IgA and IgM are normal. A liver biopsy is conducted. After a short test with non-pegylated interferon (IFN) liver enzymes remain stable and treatment with pegylated IFN-alfa-2a and ribavirin (RBV) is initiated. The patient is a "rapid viral responder" and his viral load is found under the detection limit within 4 weeks under therapy. On the 16th week, liver enzymes increase rapidly. ANA's and IgG-immunoglobulins are positive. A second lever biopsy does not confirm the diagnosis of autoimmune hepatitis and the treatment is continued under careful observation of all relevant liver parameters. 21 weeks after the initiation of the treatment, massive peripheral edema, hypoproteinemia and proteinuria are observed. The renal biopsy reveales membranous glomerulonephritis. Because of the preserved renal function, no acute immunosuppression is initiated and the treatment gets completed after overall 24 weeks. Liver and renal parameters return quickly back to normal after treatment discharge. This is the first report of a combined autoimmune reaction with development of autoimmune hepatitis and glomerulonephritis under INF and RBV antiviral therapy for a chronic hepatitis-C-infection. The occurrence of autoimmune manifestations should especially be considered in genetically susceptible individuals or those with positive autoimmunity markers. The initiation of INF for the treatment of chronic hepatitis-C-infection has to be critically evaluated since nowadays alternative, INF-free therapeutic regimens are available.
AB - A 63-year-old patient is evaluated for an unclear weight loss with general malaise and fatigue for several months. Serological examination reveales the first diagnosis of a hepatitis-C-virus-genotype-1b-infection with an initial viral load of 980 000 IU / ml. The duration of the infection is suggested to be more than 6 months. Because of the initially elevated anti-nuclear-antibodies (ANA) the diagnosis of an autoimmune hepatitis needs to be excluded. All other liver related autoantibodies and the immunoglobulins (Ig) IgG, IgA and IgM are normal. A liver biopsy is conducted. After a short test with non-pegylated interferon (IFN) liver enzymes remain stable and treatment with pegylated IFN-alfa-2a and ribavirin (RBV) is initiated. The patient is a "rapid viral responder" and his viral load is found under the detection limit within 4 weeks under therapy. On the 16th week, liver enzymes increase rapidly. ANA's and IgG-immunoglobulins are positive. A second lever biopsy does not confirm the diagnosis of autoimmune hepatitis and the treatment is continued under careful observation of all relevant liver parameters. 21 weeks after the initiation of the treatment, massive peripheral edema, hypoproteinemia and proteinuria are observed. The renal biopsy reveales membranous glomerulonephritis. Because of the preserved renal function, no acute immunosuppression is initiated and the treatment gets completed after overall 24 weeks. Liver and renal parameters return quickly back to normal after treatment discharge. This is the first report of a combined autoimmune reaction with development of autoimmune hepatitis and glomerulonephritis under INF and RBV antiviral therapy for a chronic hepatitis-C-infection. The occurrence of autoimmune manifestations should especially be considered in genetically susceptible individuals or those with positive autoimmunity markers. The initiation of INF for the treatment of chronic hepatitis-C-infection has to be critically evaluated since nowadays alternative, INF-free therapeutic regimens are available.
KW - Antiviral Agents
KW - Diagnosis, Differential
KW - Drug Therapy, Combination
KW - Glomerulonephritis, Membranous
KW - Hepatitis C, Chronic
KW - Hepatitis, Autoimmune
KW - Humans
KW - Interferon-alpha
KW - Kidney Function Tests
KW - Liver Function Tests
KW - Male
KW - Middle Aged
KW - Polyethylene Glycols
KW - Recombinant Proteins
KW - Ribavirin
KW - Case Reports
KW - Journal Article
U2 - 10.1055/s-0041-106681
DO - 10.1055/s-0041-106681
M3 - SCORING: Zeitschriftenaufsatz
C2 - 27176065
VL - 141
SP - 709
EP - 711
JO - DEUT MED WOCHENSCHR
JF - DEUT MED WOCHENSCHR
SN - 0012-0472
IS - 10
ER -