Drug Induced Pneumonitis Secondary to Treatment with Paritaprevir/Ritonavir/Ombitasvir and Dasabuvir (VIEKIRA PAK®) for Chronic Hepatitis C: Case Report of an Unexpected Life-Threatening Adverse Reaction

Abstract

VIEKIRA PAK (ritonavir-boosted paritaprevir/ombitasvir and dasabuvir) is an approved treatment for compensated patients with genotype 1 (GT1) chronic hepatitis C virus (HCV) infection. This oral regimen has minimal adverse effects and is well tolerated. Cure rates are 97% in patients infected with HCV GT 1a and 99% in those with HCV GT 1b. We report the first case of life-threatening allergic pneumonitis associated with VIEKIRA PAK. This unexpected serious adverse event occurred in a 68-year-old Chinese female with genotype 1b chronic hepatitis C and Child-Pugh A cirrhosis. One week into treatment with VIEKIRA PAK without ribavirin, she was admitted to hospital with respiratory distress and acute kidney injury requiring intensive care input. She was initially diagnosed with community acquired pneumonia and improved promptly with intravenous antibiotics and supported care. No bacterial or viral pathogens were cultured. Following complete recovery, she recommenced VIEKIRA PAK but represented 5 days later with more rapidly progressive respiratory failure, requiring intubation and ventilation, inotropic support, and haemodialysis. The final diagnosis was drug induced pneumonitis.

VIEKIRA PAK associated drug-induced interstitial lung disease: Case series with systematic review of literature

“…We performed a systematic review of the literature and only two cases of VIEKIRA PAK associated DILD have been reported to date [14,15]. The clinical features of all patients with VIEKIRA PAK associated DILD (including our two patients from our case series) are summarized in Table 1.…”

“…She made a prompt and complete recovery after cessation of VIEKIRA PAK. However when VIEKIRA PAK was reintroduced 3 weeks later the patient was readmitted for respiratory failure requiring mechanical ventilation for respiratory failure and high dose corticosteroid therapy [14]. Tarao et al reported a 77-year-old Japanese woman who reported fatigue 4 weeks into treatment with VIEKIRA PAK only for genotype 1b HCV infection.…”

Ombitasvir/paritaprevir/ritonavir+dasabuvir and ribavirin associated drug-induced liver injury and syndrome of inappropriate secretion of anti-diuretic hormone: A case report

“…In the post-marketing surveillance angioedema, erythema multiforme and drug-induced pneumonitis have been reported so far [6,7].…”