Interstitial Pneumonitis in a Patient with Chronic Hepatitis C and Chronic Renal Failure on Interferon Therapy

Eun Jung Kang; Dong Kyun Kim; Seong Ran Jeon; Hyun Sook Choi; Soung Won Jeong; Jae Young Jang; Joon Seong Lee; Soo Taek Uh

doi:10.4166/kjg.2011.58.1.47

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Kang, Kim, Jeon, Choi, Jeong, Jang, Lee, and Uh: Interstitial Pneumonitis in a Patient with Chronic Hepatitis C and Chronic Renal Failure on Interferon Therapy

Case Report

Korean J Gastroenterol 2011;58(1):47-52.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.58.1.47

Interstitial Pneumonitis in a Patient with Chronic Hepatitis C and Chronic Renal Failure on Interferon Therapy

Eun Jung Kang, Dong Kyun Kim, Seong Ran Jeon, Hyun Sook Choi, Soung Won Jeong, Jae Young Jang, Joon Seong Lee, Soo Taek Uh¹

Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea

¹Department of Allergy and Respiratory Medicine, Soonchunhyang University College of Medicine, Seoul, Korea

Correspondence to: Jae Young Jang, Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul Hospital, 657, Hannam-dong, Yongsan-gu, Seoul 140-743, Korea. Tel: +82-2-709-9863, Fax: +82-2-709-9696, E-mail: jyjang@hosp.sch.ac.kr

Received 4 December 20094 August 2010 Accepted 5 August 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

After 4-months of alpha interferon (IFN-α), a 64-year old woman with chronic hepatitis C developed a cough and dyspnea and showed diffuse infiltrative opacities on her chest X-ray. Her symptoms persisted after stopping the IFN-α therapy. Pulmonary function testing revealed a reduced forced vital capacity. High-resolution computed tomography of the lung showed peripheral and peribronchovascular ground glass attenuation and consolidation associated with reticulation. Bronchoalveolar lavage was performed for further evaluation and showed a lymphocyte level of 8.2%, an uncommon finding in IFN-α-induced interstitial pneumonitis. We performed a lung biopsy to diagnose her disease and it suggested interstitial pneumonitis. This was considered to be due to the immunomodulatory effects of INF-α. Although rare, any sign of significant pulmonary involvement should be evaluated.

Keywords: Chronic hepatitis C, Interferon, Chronic renal failure, Interstitial pneumonitis

References

1. Hoofnagle JH, Seeff LB. Peginterferon and ribavirin for chronic hepatitis C. N Engl J Med. 2006; 355:2444–2451.

2. Hoofnagle JH. Course and outcome of hepatitis C. Hepatology. 2002; 36(5 Suppl 1):S21–S29.

3. Rehermann B, Nascimbeni M. Immunology of hepatitis B virus and hepatitis C virus infection. Nat Rev Immunol. 2005; 5:215–229.

4. Bowen DG, Walker CM. Adaptive immune responses in acute and chronic hepatitis C virus infection. Nature. 2005; 436:946–952.

5. Strader DB, Wright T, Thomas DL, Seeff LB. American Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C. Hepatology. 2004; 39:1147–1171.

6. Lauer GM, Walker BD. Hepatitis C virus infection. N Engl J Med. 2001; 345:41–52.

7. Davis GL, Balart LA, Schiff ER, et al. Treatment of chronic hepatitis C with recombinant interferon alfa. A multicenter randomized, controlled trial. Hepatitis Interventional Therapy Group. N Engl J Med. 1989; 321:1501–1506.

8. Onoda K, Takai K, Sanada M, Aoki S, Watanabe T. Autoimmune hemolytic anemia induced by alpha-interferon therapy in a case of IgG-kappa type multiple myeloma. Rinsho Ketsueki. 1992; 33:844–846.

9. Schilling PJ, Kurzrock R, Kantarjian H, Gutterman JU, Talpaz M. Development of systemic lupus erythematosus after interferon therapy for chronic myelogenous leukemia. Cancer. 1991; 68:1536–1537.

10. Schattner A. Interferons and autoimmunity. Am J Med Sci. 1988; 295:532–544.

11. Quesada JR, Talpaz M, Rios A, Kurzrock R, Gutterman JU. Clinical toxicity of interferons in cancer patients: a review. J Clin Oncol. 1986; 4:234–243.

12. Hizawa N, Kojima J, Kojima T, et al. A patient with chronic hepatitis C who simultaneously developed interstitial pneumonia, hemolytic anemia and cholestatic liver dysfunction after al-pha-interferon administration. Intern Med. 1994; 33:337–341. July 2011.

13. Kumar KS, Russo MW, Borczuk AC, et al. Significant pulmonary toxicity associated with interferon and ribavirin therapy for hepatitis C. Am J Gastroenterol. 2002; 97:2432–2440.

14. Silva MO, Reddy KR, Jeffers LJ, Hill M, Schiff ER. Interferon-in-duced chronic active hepatitis? Gastroenterology. 1991; 101:840–842.

15. Okanoue T, Sakamoto S, Itoh Y, et al. Side effects of high-dose interferon therapy for chronic hepatitis C. J Hepatol. 1996; 25:283–291.

16. Dumoulin FL, Leifeld L, Sauerbruch T, Spengler U. Autoimmunity induced by interferon-alpha therapy for chronic viral hepatitis. Biomed Pharmacother. 1999; 53:242–254.

17. Wolf Y, Haddad R, Jossipov J, Werbin N. Alpha-interferon induced severe pneumonitis. J Toxicol Clin Toxicol. 1997; 35:113–114.

18. Bini EJ, Weinshel EH. Severe exacerbation of asthma: a new side effect of interferon-alpha in patients with asthma and chronic hepatitis C. Mayo Clin Proc. 1999; 74:367–370.

19. Chin K, Tabata C, Sataka N, Nagai S, Moriyasu F, Kuno K. Pneumonitis associated with natural and recombinant interferon alfa therapy for chronic hepatitis C. Chest. 1994; 105:939–941.

Fig. 1.

(A, B) CT on admission showing peripheral and peribronchovascular ground glass attenuation and consolidations. (C, D) Repeated CT scan performed after discontinuation of interferon. Bilateral lung parenchymal lesions show improvement.

Fig. 2.

(A) Patchy areas of organizing pneumonia showing polypoid plugs of loose connective tissue (H&E, ×40). (B) Polypoid plugs of organizing pneumonia and acute alveolar hemorrhage (H&E, ×40). (C) An organizing intraluminal plug with chronic inflammatory infiltrate (H&E, ×100).(D) Chronic interstitial pneumonia pattern with interstitial fibrosis and inflammation (H&E, ×40).

Table 1.

The Cases of Interferon-induced Pulmonary Complications

No.	FEV1 (L) (% Predicted)	FVC (L) (% Predicted)	FEV1/FVC (% Predicted)	DLCO (ML/min/mmHg) (% Predicted)
1: On admission	93	75	88	45
2: After 1 mo	100	85	84	46
3: After 2 mo	110	95	83	58

FEV1, forced expiratory volume in one second; FVC, forced vital capacity; DLCO, carbon monoxide diffusing capacity.

Table 2.

Pulmonary Function Tests

	Gender	Age	Comorbidity	Type of IFN	Duration	PFT	Biopsy / BAL	Outcome
Kumar et al.¹³	Female	48	I.V. drug user	IFN-α 2b	24 wk	Reduced diffusing capacity	Bronchial mucosa	Resolved with steroids
				PEG IFN-α 2a	6 wk
	Male	50		IFN-α 2b	4 wk	Restrictive pattern	Patch fibrosing interstitial pneumonitis	Mild excertional dyspnea persists after 1 yr on steroids
Chin et al.¹⁹	Female	58		Recombinant IFN	16 wk		BAL-Lymphocyte 74.2%, CD4/CD8 0.16	Resolved after the cessation of IFN treatment
	Female	72	Pulmonary emphysema	Natural IFN (Sumiferon)	10 days	Obstructive pattern		Maintain intermittent steroid pulse therapy
	Male	56	Taking herbal drugs	IFN (IntronA)	2 wk		BAL-Lymphocyte 38.7%, CD4/CD8 0.10	Resolved with steroid

FEV1, forced expiratory volume in one second; FVC, forced vital capacity; DLCO, carbon monoxide diffusing capacity; Aug, August; Sep, September; Oct, October.

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ORCID iDs: Seong Ran Jeon
https://orcid.org/http://orcid.org/0000-0001-6970-9737
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