Many patients with chronic hepatitis C (HCV) infection undergoing treatment with pegylated interferon-alpha (PEG-IFN-alpha) and ribavirin develop neutropenia requiring dose reduction or granulocyte colony-stimulating factor (G-CSF) supplement. We analysed the database of patients who completed treatment for chronic HCV infection between 2003 and 2006. Patients with absolute neutrophil counts below 1000 cells/microL were initiated on G-CSF (G-CSF group) while a matching group of patients who received anti-HCV treatment without developing neutropenia were used as a control group (non-G-CSF group). Patients on the G-CSF arm were divided into two subgroups based on the timing of G-CSF administration relative to PEG-IFN-alpha administration. Of the 163 patients with HCV infection, 30 patients received G-CSF, most of who were maintained on 300 microg of G-CSF once a week. Administration of G-CSF 2 days before or after each dose of PEG-IFN-alpha did not make a significant difference in the neutrophil counts. In the G-CSF arm, 23 of 30 patients (77%) had undetectable end-of-treatment viral response which was comparable with 27 of 30 in the control group (90%; P = 0.17). There was no statistically significant difference in the sustained viral response between the two groups (61%vs 76%, P = 0.18). In most patients PEG-IFN-alpha induced neutropenia improved with a once-a-week dose of G-CSF with a comparable virological outcome. Timing of G-CSF administration did not make any significant impact on the patient's neutrophil counts but was better tolerated when given 2 days apart from PEG-IFN-alpha.
We report a case of septic right superior ophthalmic vein thrombosis complicated by left sphenoid sinusitis with methicillin-sensitive Staphylococcus aureus (MSSA). Early recognition by clinical symptoms, and computed tonography (CT) and magnetic resolution image (MRI) of the head and sinus is needed for prompt surgical drainage of the sinus and appropriate antimicrobial therapy. The use of steroids and anticoagulation for this condition is still debated.
We report a case of septic right superior ophthalmic vein thrombosis complicated by left sphenoid sinusitis with methicillin-sensitive Staphylococcus aureus (MSSA). Early recognition by clinical symptoms, and computed tonography (CT) and magnetic resolution image (MRI) of the head and sinus is needed for prompt surgical drainage of the sinus and appropriate antimicrobial therapy. The use of steroids and anticoagulation for this condition is still debated.
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