Digestive Diseases and Sciences

, Volume 40, Issue 10, pp 2113–2116 | Cite as

Primary biliary cirrhosis induced by interferon-α therapy for hepatitis C virus infection

  • Emilio D'Amico
  • Marino Paroli
  • Vincenzina Fratelli
  • Carlo Palazzi
  • Vincenzo Barnaba
  • Francesco Callea
  • Giuseppe Consoli
Liver: Infectious, Inflammatory, and Metabolic Disorders Case Report

Summary

Interferon-α is known to exacerbate and in some cases induce a variety of autoimmune disorders. In this report we describe the onset of primary biliary cirrhosis in a 55-year-old woman without evidence of preexisting autoimmune diseases receiving recombinant interferon-α2a for chronic active hepatitis C. Shortly after discontinuating interferon therapy, alkaline phosphatase levels started to rise up to three times the normal range. Anti-mithocondrial antibodies were found to be positive at a high titer, and liver biopsy showed a picture of chronic active hepatitis along with primary biliary cirrhosis features (overlap syndrome). Primary biliary cirrhosis should be considered in the differential diagnosis in any patient treated with interferon-α with unexplained elevation of serum alkaline phosphatase.

Key Words

Primary biliary cirrhosis interferon-α chronic active hepatitis hepatitis C virus 

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References

  1. 1.
    McFarlane IG, Smith HM, Johnson PJ, Bray GP, Vergani D, Williams R: Hepatitis C virus antibodies in chronic active hepatitis: pathogenetic factor or false-positive results? Lancet 335:754–757, 1990Google Scholar
  2. 2.
    Davis GL, Balart LA, Shiff ER, Lindsay K, Bodenheimer HC Jr, Perrillo RP, Carey W, Jacobson IM, Payne J, Dienstag JL, et al: Treatment of chronic hepatitis C with recombinant interferon alpha. N Engl J Med 321:1501–1506, 1989Google Scholar
  3. 3.
    Mayet WJ, Hess G, Gerken G, Rossol S, Voth R, Manns M, MeyerzumBushenfelde KH: Treatment of chronic type B hepatitis with recombinant alpha interferon induces autoantibodies non specific for autoimmune chronic hepatitis. Hepatology 10:24–28, 1989Google Scholar
  4. 4.
    Ronnblom L, Alm G, Oberg K: Autoimmunity after alphainterferon therapy for malignant carcinid tumors. Ann Intern Med 115:178–183, 1991Google Scholar
  5. 5.
    Lisker-Melman M, Di Bisceglie A, Usala SJ, Weintraub B, Murray LM, Hoofnagle JH: Development of thyroid disease during therapy of chronic viral hepatitis with interferon alfa. Gastroenterology 102:2155–2160, 1992Google Scholar
  6. 6.
    Fabris P, Betterle C, Floreani A, Greggio NA, de Lazzari F, Naccarato R, Chiaramonte M: Development of type I diabetes mellitus during interferon alfa therapy for chronic HCV hepatitis. Lancet 340:548, 1992Google Scholar
  7. 7.
    Funk J, Langeland T, Schrumpf E, Hannsen LE: Psoriasis induced by interfreon-alpha. Br J Dermatol 125:463–465, 1991Google Scholar
  8. 8.
    Papo T, Marcellin P, Bernau J, Durand F, Poynard T, Benhamou J-P: Autoimmune chronic hepatitis exacerbated by alpha-interferon. Ann Intern Med 116:51–53, 1992Google Scholar
  9. 9.
    Maguire JE, Gresser I, Williams AH, Kielpinski GL, Colvin RB: Modulation of expression of MHC antigens in the kidneys of mice by murine interferon alpha/beta. Transplantation 49:130–134, 1990Google Scholar
  10. 10.
    Franco A, Barnaba V, Natali PG, Balsano C, Musca A, Balsano F: Expression of class I and class II major histocompatibility complex antigens on human hepatocytes. Hepatology 8:449–454, 1988Google Scholar
  11. 11.
    Romagnani S: Human Th1 and Th2 subsets: Regulation of differentiation and role in protection and immunopathology. Int Arch Allergy Immunol 98:279–285, 1992Google Scholar
  12. 12.
    Romagnani S: Induction of Th1 and Th2 responses: A key role for the “natural” immune response? Immunol Today 10:379–381, 1992Google Scholar
  13. 13.
    Barnaba V, Franco A, Paroli M, Benvenuto R, De Petrillo G, Burgio VL, Santilio I, Balsano C, Bonavita MS, Cappelli G, et al: Selective expansion of cytotoxic T lymphocytes with a CD4+CD56+surface phenotype and a T helper type 1 profile of cytokine secretion in the liver of patients chronically infected with hepatitis B virus. J Immunol 152:3074–3087, 1994Google Scholar
  14. 14.
    Mishiro S, Hoshi Y, Takeda K, Yoshikawa A, Gotanga T, Takahashi K, Akahane Y, Yoshizawa H, Okamoto H, Tsuda F, et al: Non-A, non-B hepatitis specific antibodies directed at a host-derived epitope: Implication for an autoimmune process. Lancet 336:1400–1403, 1990Google Scholar
  15. 15.
    Garson JA, Lenzi M, Ring C, Cassani F, Balladrini G, Briggs M, Tedder RS, Bianchi FB: Hepatic C viremia in adults with type 2 autoimmune hepatitis. J Med Virol 32:223–226, 1991Google Scholar
  16. 16.
    Haddad J, Deny P, Munz-Gotheil C, Ambrosini J-C, Trinchet J-C, Pateron D, Mal F, Callard P, Beaugrand M: Lymphocytic scialadenitis of Sjogren's syndrome associated with chronic hepatitis C virus liver disease. Lancet 339:321–323, 1992Google Scholar
  17. 17.
    Aceti A, Taliani G, Sorice M, Amendola MA: HCV and Sjogren's syndrome. Lancet 339:1425–1426, 1992Google Scholar
  18. 18.
    Suarez A, Riestra S, Rodriguez M, Navascues CA, Tevar F, Perez R, Rodrigo L, Sanchez Lombrona JL: Prevalence of antibodies against hepatitis C virus in primary biliary cirrhosis and autoimmune chronic hepatitis. Arch Virol 4(S):210–211. 1992Google Scholar
  19. 19.
    McFarlane IG, Smith HM, Johnson PJ, Bray GP, Vergani D, Williams R: Hepatitis C virus antibodies in chronic active hepatitis: Pathogenic factor or false-positive result? Lancet 335:754–757, 1990Google Scholar
  20. 20.
    Paroli M, Franco A, Santilio I, Balsano C, Levrero M, Barnaba V: Cyclosporin A in the treatment of autoimmune chronic active hepatitis with or without circulating antibodies against hepatitis C virus. Int J Immunother 8:135–140, 1992Google Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Emilio D'Amico
    • 1
    • 2
  • Marino Paroli
    • 1
    • 2
  • Vincenzina Fratelli
    • 1
    • 2
  • Carlo Palazzi
    • 1
    • 2
  • Vincenzo Barnaba
    • 1
    • 2
  • Francesco Callea
    • 1
    • 2
  • Giuseppe Consoli
    • 1
    • 2
  1. 1.Ospedale di Pescara, Divisione di Reumatologia, Pescara; Istituto di Clinica Medica IUniversità “La Sapienza”Roma
  2. 2.I Servizio di Anatomia PatologicaSpedali Civili di BresciaItaly

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