Dilated cardiomyopathy and hypothyroidism associated with pegylated interferon and ribavirin treatment for chronic hepatitis C: case report and literature review

Abstract

Pegylated interferon alpha (Peg IFN-α) in combination with ribavirin is the backbone of treatment in chronic hepatitis C (CHC). Cardiotoxicity due to interferon therapy is rare. The most frequent cardiovascular complications are arrhythmias and ischemic manifestations. Cardiomyopathy is extremely rare but can be life threatening. We present the case of a 41-year-old female patient with CHC in whom Peg IFN-α induced dilated cardiomyopathy and hypothyroidism. Chest radiography showed an enlarged and globular cardiac silhouette and pulmonary congestion. Echocardiography showed decreased left ventricular systolic function with an ejection fraction of 32% and fractional shortening of 15%. Cardiomyopathy had a complete remission after cessation of antiviral therapy with short-term heart failure medications and supportive care. Then we review the current literature about interferon induced cardiomyopathy in patients with HCV infection, as well as share our clinical experience in diagnosing and managing this rare complication.

Assessment of the Potential Adverse Events Related to Ribavirin-Interferon Combination for Novel Coronavirus Therapy

“…The drug labels list the possible adverse drug events (ADEs), but less attention has been paid to the potential adverse events related to ribavirin-interferon combination, mainly including lower respiratory tract infection, suicide attempt, gastrointestinal ulcer, cerebral hemorrhage, mental disorder, and hallucinations. Studies have confirmed that ribavirin-interferon combination can lead to arteriosclerosis [ 3 ] and even cause heart enlargement in patients to develop into dilated cardiomyopathy [ 4 ]. However, all these ADEs are not listed in the drug labels, due to the delay of the update of the labels and the complexity of united medication.…”

Acute changes in cardiac function by direct acting antiviral therapy for hepatitis C−infected patients with thalassemia

“…Although the PEGylated interferon plus ribavirin has no significant effect on the cardiac function of HCV−infected patients without cardiac diseases, some studies have reported worsening cardiac function in patients with known cardiac diseases …”

“…6 Although the PEGylated interferon plus ribavirin has no significant effect on the cardiac function of HCV−infected patients without cardiac diseases, 7,8 some studies have reported worsening cardiac function in patients with known cardiac diseases. 9,10 HCV treatment has revolutionized after the introduction of new direct acting antiviral (DAA) drugs. 8,11,12 However, data on the effects of these new HCV drugs on the cardiac function of patients with and without a history of cardiac diseases are limited.…”

Delta hepatitis-related thyroid disease: a unique phenomenon

“…There have been many studies and case reports about the effect of IFN-based therapies on thyroid function tests in hepatitis C virus (HCV) patients. Interferon-related side effects involving thyroid glands are usually associated with a self-limiting course but can cause overt thyroid diseases in persons with pre-existing thyroid disease [ 5 , 6 ]. An association of hypothyroidism with IFN treatment has also been reported in many studies involving HBV patients [ 7 ], but no tests have been conducted among patients with C-HDV infection in whom the only treatment option is IFN.…”