Fatal cardiomyopathy associated with pegylated interferon/ribavirin in a patient with chronic hepatitis C

Abstract

We report the case of a 45-year-old man with HCV treated with pegylated interferon-alpha/ribavirin, in whom fatal cardiomyopathy occurred. Cardiomyopathy is a rare complication of high dose of standard interferon but has never been reported with pegylated interferon. The relationship between pegylated interferon-alpha/ribavirin and the development of cardiomyopathy is highly probable for the following reasons: (1) a cardiologist consultation with specific investigations had been performed before treatment excluding a pre-existing cardiomyopathy; (2) symptoms of advanced dilated cardiomyopathy appeared immediately after the end of treatment; (3) other causes of cardiomyopathy have been ruled out. In all except one of the 21 reported cases with standard interferon, cardiomyopathy was reversible. In our patient, fatal cardiomyopathy occurred with a usual dose of pegylated interferon-alpha. Clinicians should be aware of this potential complication when evaluating the ratio benefit/risk of treatment in patients with chronic hepatitis C infection.

Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis

“…Second, several chronic comorbidities, including hypertension, CVD, CKD, and diabetes, may render the affected organs and tissues susceptible to virus infection via an impaired immune response [74]. Third, certain antiviral drugs such as chloroquine [62], ribavirin [63,68], and lopinavir/ritonavir [67] have side effects that can include organ damage. Fourth, acute respiratory distress syndrome-(ARDS-) induced hypoxia can promote damage in organs outside of the respiratory system [64,75].…”

“…For example, although chloroquine appears to block SARS-CoV-2 infection in vitro and has been recommended for clinical use by the National Health Commission of China [61], both chloroquine and its derivative hydroxychloroquine have been reported to cause cardiac side effects, including impaired conduction and hypertrophic cardiomyopathy [62]. Other drugs recommended for treating COVID-19, including interferon alpha and ribavirin, may also potentially cause cardiac damage [63]. Moreover, virus-induced cytokine storm and pneumonia-associated hypoxia may also contribute to the development ACI and/or the progression of ACI into heart failure in critically ill SARS-CoV-2-infected patients [64].…”

Congestive heart failure is a rare event in patients receiving imatinib therapy

“…15 DM, hypertension, coronary artery disease, arrhythmia, and history of CHF (all well known heart failure risk factors) [16][17][18] were present in 18 of the 22 patients. In addition, 13 (59%) patients had previously received 1 or more known cardiotoxic drugs [19][20][21] (IFN-␣ in 12 patients, anthracyclines in 3 patients, and anagrelide in 1 patient). CHF could have been precipitated or exacerbated by imatinib-associated fluid retention in these patients with a possibly already compromised heart function.…”

Pegylated Interferons: Clinical Applications in the Management of Hepatitis C Infection

“…Risk reduction measures should also be considered in patients at a high risk for cardiovascular complications. A recent case report by Condat (2006) details a case of fatal cardiomyopathy in a patient receiving PEG-IFN/RBV therapy.…”