Graves' ophthalmopathy and tongue cancer complicated by peg-interferon α-2b and ribavirin therapy for chronic hepatitis C: A case report and review of the literature

Abstract

Hepatitis C virus (HCV) infection induces not only chronic liver disease, but also extrahepatic manifestations such as thyroid disease and oral cancer. Thyroid dysfunction is also a complication known to be associated with interferon (IFN) therapy for HCV infection. We report on a 69-year-old Japanese man who developed Graves' ophthalmopathy and tongue cancer (malignant transformation of leukoplakia) while receiving peg-interferon (Peg-IFN) α-2b and ribavirin (RBV) treatment for chronic hepatitis C. This patient had no history of thyroid disease before the combination therapy, but did have bilateral leukoplakia of the tongue. The leukoplakia lesions did not change until 20 weeks after the start of the combination therapy, and ophthalmopathy was not diagnosed until 47 weeks later. As ophthalmopathy is considered to be a severe adverse event induced by Peg-IFN α-2b plus RBV, therapy was discontinued after 47 weeks. The patient received a partial glossectomy to remove the malignant neoplasm as well as extraocular muscle surgery for the ophthalmopathy, and was treated with an antithyroid agent and steroids. In conclusion, it is necessary to clinically examine organs other than the liver in patients with HCV infection.