Case Report
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World J Hepatol. Jun 27, 2014; 6(6): 448-452
Published online Jun 27, 2014. doi: 10.4254/wjh.v6.i6.448
Grade 4 febrile neutropenia and Fournier’s Syndrome associated with triple therapy for hepatitis C virus: A case report
Kelly Cristhian Lima Oliveira, Emili de Oliveira Bortolon Cardoso, Suzana Carla Pereira de Souza, Flávia Souza Machado, Carlos Eduardo Alves Zangirolami, Alecsandro Moreira, Giovanni Faria Silva, Cássio Vieira de Oliveira
Kelly Cristhian Lima Oliveira, Emili de Oliveira Bortolon Cardoso, Suzana Carla Pereira de Souza, Flávia Souza Machado, Carlos Eduardo Alves Zangirolami, Alecsandro Moreira, Giovanni Faria Silva, Cássio Vieira de Oliveira, Division of Gastroenterology, Department of Internal Medicine, Botucatu School of Medicine, 18618-970 São Paulo, Brazil
Author contributions: Oliveira KCL conceived and coordinated the study and participated in the data collection, acquisition of radiological figures and writing the manuscript; Cardoso EOB, de Souza SCP, Machado FS, Zangirolami CEA and Moreira A participated in the study design, data collection and writing the manuscript; Silva GF and de Oliveira CV coordinated the study, participated in the data collection and assisted in writing the manuscript.
Correspondence to: Kelly Cristhian Lima Oliveira, MD, Division of Gastroenterology, Department of Internal Medicine, Botucatu School of Medicine, Rubião Junior District S/N, 18618-970 São Paulo, Brazil. kellycloliveira@hotmail.com
Telephone: +55-82-99918631 Fax: +55-14-38822238
Received: February 20, 2014
Revised: May 7, 2014
Accepted: May 16, 2014
Published online: June 27, 2014
Processing time: 135 Days and 8.1 Hours
Abstract

The use of triple therapy for hepatitis C not only increases the rate of sustained virological responses compared with the use of only interferon and ribavirin (RBV) but also leads to an increased number of side effects. The subject of this study was a 53-year-old male who was cirrhotic with hepatitis C virus genotype 1 A and was a previous null non-responder. We initially attempted retreatment with boceprevir (BOC), Peg-interferon and RBV, and a decrease in viral load was observed in the 8th week. In week 12, he presented with disorientation, flapping, fever, tachypnea, arterial hypotension and tachycardia. He also exhibited leucopenia with neutropenia. Cefepime and filgrastim were initiated, and treatment for hepatitis C was suspended. A myelogram revealed hypoplasia, cytotoxicity and maturational retardation. After 48 h, he developed bilateral inguinal erythema that evolved throughout the perineal area to the root of the thighs, with exulcerations and an outflow of seropurulent secretions. Because we hypothesized that he was suffering from Fournier’s Syndrome, treatment was replaced with the antibiotics imipenem, linezolid and clindamycin. After this new treatment paradigm was initiated, his lesions regressed without requiring surgical debridement. Triple therapy requires knowledge regarding the management of adverse effects and drug interactions; it also requires an understanding of the importance of respecting the guidelines for the withdrawal of treatment. In this case report, we observed an adverse event that had not been previously reported in the literature with the use of BOC.

Keywords: Hepatitis C; Treatment; Boceprevir; Telaprevir; Adverse events

Core tip: Triple therapy is a recently developed strategy for the treatment of hepatitis C that requires extensive knowledge of adverse effects and drug interactions. It also requires an appreciation of the importance of respecting the guidelines for treatment withdrawal. The case report presented here describes a serious adverse event associated with this new therapy that has not previously been reported in the literature. This finding emphasizes the importance of adequately managing patients according to international clinical protocols, and our study allows for an exchange of experience among experts in the conduct of real-life cases.