Cutaneous sarcoidosis during interferon alfa and ribavirin treatment of hepatitis C virus infection: two cases

Abstract

Interferon-induced sarcoidosis is well documented. We report two new cases of sarcoidosis in two patients with hepatitis C virus infection treated with interferon alfa and ribavirin. These patients developed cutaneous sarcoidosis about 3 months after the beginning of the combination therapy. Spontaneous regression of the lesions was noted after discontinuation of the treatment. There have been more than 20 observations of the appearance or aggravation of this granulomatosis with interferon alfa and more recently with the combination of interferon alfa plus ribavirin. Dermatological signs are found in 50% of cases, and are often diagnostic. Other clinical symptoms of sarcoidosis resemble side-effects of interferon. The evolution is fairly stereotypical and is marked by a regression of the lesions following a dose reduction or curtailment of interferon. Interferon alfa acts by stimulating the T-helper (Th) 1 immune response. In addition to its antiviral action, ribavirin also enhances the Th1 response. Indeed, the superiority of the combination of interferon alfa and ribavirin in terms of antiviral action is corroborated by the enhancement of a Th1-type immune reaction by this combination. At the same time, this immune cell reaction triggers a greater granulomatous reaction.

Two Cases of Interferon-Alpha-Induced Sarcoidosis Koebnerized along Venous Drainage Lines: New Pathogenic Insights and Review of the Literature of Interferon-Induced Sarcoidosis

“…This is consistent with a previous report of IFN-induced sarcoidosis observing that in 50% of cases, skin involvement is the first manifestation of sarcoidosis, and that in 20% of these cases sarcoidosis remains confined to the skin [15]. The onset of IFN-α-induced sarcoidosis varies from 15 days to 30 months after the beginning of treatment [16]. Ninety-five percent of the cases with IFN-α-induced sarcoidosis have been reported to improve or remit after discontinuation or a decrease in the dosage of the drug (table 1).…”

Association between IFNA genotype and the risk of sarcoidosis

“…First, there is an increasing number of reported cases of sarcoidosis induced by IFN-α therapy (Cogrel et al 2002;Raanani and BenBassat 2002). Furthermore, in some cases, the sarcoid lesions improved following dose reduction or cessation of the therapy.…”

Sarcoïdose chez un patient traité par interféron pégylé pour une hépatite chronique C

“…La plus grande utilisation de l'interféron et surtout de sa forme pégylée dans le traitement des hépatites virales chroniques est à l'origine de l'augmentation du nombre de cas [3]. Il est noté un sex-ratio égal à 1 [4,5], un âge variable supérieur à 60 ans [6], une atteinte cutanée isolée ou associée à une atteinte pulmonaire [7]. Benali et al rapportent une série de 31 observations de sarcoïdose induite par l'interferon chez des patients traités pour une HVC avec 21 cas d'atteinte cutanée, 17 cas d'atteinte pulmonaire et 7 cas associant les deux [6].…”

“…Le délai de survenue est variable entre 2 semaines après le début de traitement jusqu'à 30 mois après son arrêt [5,10,16]. La maladie survient en général dans les 6 mois après l'arrêt du traitement [8].…”