Secondary bronchiolitis obliterans organizing pneumonia during treatment of chronic hepatitis C: role of pegylated interferon alfa-2a

Abstract

The treatment of chronic hepatitis C has frequent side effects such as cytopenias and neuropsychiatric symptoms. However, pulmonary toxicity associated with interferon is rarely described. This paper describes the clinical case of a 67-year-old female patient with chronic hepatitis C who presented an acute onset of dry cough, dyspnoea, and fever 36 weeks after the use of pegylated interferon alfa-2a and ribavirin. The lung biopsy confirmed the diagnosis of a bronchiolitis obliterans organizing pneumonia (BOOP). Corticotherapy was initiated, with clinical and radiological improvement. This paper aims to advise physicians to this occasional, though severe, adverse event related to hepatitis C virus (HCV) treatment.O tratamento da hepatite C crônica apresenta efeitos colaterais frequentes como citopenias e sintomas neuropsiquiátricos. Contudo, a toxicidade pulmonar associada ao interferon é raramente descrita. Relatamos o caso de uma paciente com 67 anos que apresentou início agudo de tosse, dispnéia e febre após 36 semanas de uso do interferon peguilado alfa-2a e ribavirina. A biópsia pulmonar confirmou o diagnóstico de bronquiolite obliterante com pneumonia em organização, com significativa melhora clínico-radiológica após instituída a corticoterapia. Este relato de caso visa alertar os médicos para a possibilidade desse ocasional, embora grave, evento adverso associado ao tratamento da hepatite C.