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.

Organizing Pneumonia Associated with Pegylated Interferonαand Ribavirin Therapy

“…According to ATS/ERS classification cryptogenic organizing pneumonia is categorized as a subtype of idiopathic interstitial pneumonia [ 14 ]. On thorough review of the literature in English language we found a total of six cases of organizing pneumonia that have been associated with IFN- α /ribavirin combination therapy for chronic hepatitis C infection (summarized in Table 1 ) [ 4 – 8 ]. Three of six cases were associated with pegylated IFN- α .…”

Interstitial pneumonia associated to peginterferon alpha-2a: A focus on lung function

“…[ 3 4 5 ] The majority of the descriptions have been reported as a consequence of pegylated IFN α-2b;[ 5 6 7 ] while few events with pegylated IFN α-2a. [ 6 8 9 10 ]…”

Development of bronchiolitis obliterans organizing pneumonia during standard treatment of hepatitis C with Peg-IFNα2b

“…Its clinical manifestations, subacute cough, dyspnea or fever, are accompanied by alveolar and/or interstitial infiltrates (sometimes migratory and even recurrent) and abnormalities in bronchoalveolar lavage (marked lymphocytosis, often with neutrophilia, and/or eosinophilia). This disease is partly known to develop after use of immunomodulating agents, and a firm diagnosis is based on demonstration of foci of organizing pneumonia in samples obtained by transbronchial or surgical biopsy as was done in this report [ 2 , 4 , 5 ].…”

“…Previously, some cases of pulmonary complications such as the exacerbation of underlying idiopathic pulmonary fibrosis or development of irreversible pulmonary hypertension during or after treating HCV with IFNα have been reported in patients with previous interstitial lung diseases, and these toxicities of IFNα are thought to be related to its immunostimulatory effects [ 2 , 3 ]. Also, development of secondary interstitial lung disease after use of Peg-IFNα2a has been reported [ 5 ]. This case demonstrates a biopsy proven BOOP as the pulmonary complication of Peg-IFNα2b treatment in a hepatitis C patient without any previous history of being diagnosed with pulmonary diseases.…”

“…This case demonstrates a biopsy proven BOOP as the pulmonary complication of Peg-IFNα2b treatment in a hepatitis C patient without any previous history of being diagnosed with pulmonary diseases. Given that IFNα is now a standard therapy for HCV infection and that pulmonary complication can occur in both patients with or without underlying lung disease [ 5 ], pulmonary function and the chest radiography should be carefully monitored during treatment in hepatitis C patients who are on standard regimen including Peg-IFNα2b not only in those with known pulmonary diseases or during the use of Peg-IFNα2a. Fortunately, this complication may easily be overcome when recognized and treated at earlier phases.…”