Case Report
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 14, 2006; 12(30): 4908-4910
Published online Aug 14, 2006. doi: 10.3748/wjg.v12.i30.4908
Retinal vein thrombosis associated with pegylated-interferon and ribavirin combination therapy for chronic hepatitis C
Iman Zandieh, Mohamed Adenwalla, Cindy Cheong-Lee, Patrick E Ma, Eric M Yoshida
Iman Zandieh, Cindy Cheong-Lee, Eric M Yoshida, Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Mohamed Adenwalla, Patrick E Ma, Department of Ophthal-mology, University of British Columbia, Vancouver, British Columbia, Canada
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Eric M Yoshida, Vancouver General Hospital, Division of Gastroenterology, 100-2647 Willow Street, Vancouver, BC, V5Z 3P1, Canada. eyoshida@interchange.ubc.ca
Telephone: +1-604-8755371 Fax: +1-604-8755373
Received: March 13, 2006
Revised: April 11, 2006
Accepted: April 21, 2006
Published online: August 14, 2006
Abstract

An estimated 300 million people worldwide suffer from chronic hepatitis C with a prevalence of 0.8%-1.0% of the general population in Canada. An increasing pool of evidence exists supporting the use of pegylated- interferon (pegIFN) and ribavirin combination therapy for hepatitis C. We report a 49-year old male of North American aboriginal descent with chronic hepatitis C (genotype 2b). Biopsy confirmed that he had cirrhosis with a 2-wk history of left eye pain and decreased visual acuity. He developed retinal vein thrombosis after 16 of 24 wk of pegIFN-α 2a and ribavirin combination therapy. He was urgently referred to a retinal specialist and diagnosed with non-ischemic central retinal vein occlusion of the left eye. PegIFN and ribavirin combination therapy was discontinued and HCV RNA was undetectable after 16 wk of treatment. Hematologic investigations revealed that the patient was a factor V Leiden heterozygote with mildly decreased protein C activity. Our patient had a number of hypercoagulable risk factors, including factor V Leiden heterozygosity, cirrhosis, and hepatitis C that alone would have most likely remained clinically silent. We speculate that in the setting of pegIFN treatment, these risk factors may coalesce and cause the retinal vein thrombosis.

Keywords: Interferon; Pegylated-interferon; Hepatitis C; Cirrhosis; Retinal vein thrombosis; Thrombosis; Central retinal vein occlusion