Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 28, 2015; 7(12): 1718-1722
Published online Jun 28, 2015. doi: 10.4254/wjh.v7.i12.1718
Severe immune thrombocytopenia after peg-interferon-alpha2a, ribavirin and telaprevir treatment completion: A case report and systematic review of literature
Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella
Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy
Author contributions: Arena R and Mazzella G wrote the paper; Cecinato P, Lisotti A, Buonfiglioli F, Calvanese C and Grande G performed literature search; Montagnani M and Azzaroli F reviewed the paper for important intellectual content.
Ethics approval: The study was reviewed and approved by the Institutional Review Board (IRB) of the S.Orsola-Malpighi Hospital of Bologna; the IRB confirmed the retrospective design of the study (case report) which did not required any further documentation.
Informed consent: The patient provided written informed consent for antiviral treatment and for anonymous review of clinical data for research purpose.
Conflict-of-interest: All Authors declare no conflict of interest for this study and for the preparation of this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Andrea Lisotti, MD, Department of Medical and Surgical Sciences - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy. lisotti.andrea@gmail.com
Telephone: +39-051-2144120 Fax: +39-051-2086001
Received: March 21, 2015
Peer-review started: March 22, 2015
First decision: April 10, 2015
Revised: May 1, 2015
Accepted: May 27, 2015
Article in press: May 28, 2015
Published online: June 28, 2015
Processing time: 99 Days and 18.7 Hours
Abstract

Mild to moderate autoimmune thrombocytopenia (AITP) is a common finding in patients receiving interferon-based antiviral treatment, due to bone marrow suppression. Here we report the case of a patient with chronic genotype 1b hepatitis C virus (HCV) infection treated with pegylated-interferon alpha-2a, ribavirin and telaprevir for 24 wk; the patient developed severe AITP three weeks after treatment withdrawal. We performed a systematic literature search in order to review all published cases of AITP related to HCV antiviral treatment. To our knowledge, this is the second case of AITP observed after antiviral treatment withdrawal. In most published cases AITP occurred during treatment; in fact, among 24 cases of AITP related to interferon-based antiviral treatment, only one occurred after discontinuation. Early diagnosis of AITP is a key factor in order to achieve an early interferon discontinuation; in the era of new direct antiviral agents those patients have to be considered for interferon-free treatment regimens. Prompt prescription of immuno-suppressant treatment (i.e., corticosteroids, immunoglobulin infusion and even rituximab for unresponsive cases) leads to favourable prognosis in most of cases. Physicians using interferon-based treatments should be aware that AITP can occur both during and after treatment, specially in the new era of interferon-free antiviral treatment. Finally, in the case of suspected AITP, presence of anti-platelet antibodies should be checked not only during treatment but also after discontinuation.

Keywords: Autoimmune thrombocytopenia; Pegylated interferon; Chronic hepatitis C; Viral hepatitis; Anti-platelet antibody

Core tip: This is the second case report of autoimmune thrombocytopenia (AITP) occurred after peg-interferon/ribavirin treatment completion: generally, AITP was observed in course of interferon treatment. To our knowledge, among 24 interferon-related AITP cases reported in literature, in 23 cases the side effect occurred during treatment while in only one after treatment completion. Physicians using interferon-based antiviral therapy should be aware that acute AITP can occur both during and after treatment; in the case of suspected AITP, presence of anti-platelet antibodies should be checked not only during treatment but also after discontinuation.