Severe immune thrombocytopenia after peg-interferonalpha2a, ribavirin and telaprevir treatment completion: a case report and systematic review of literature  

作　　者：Rosario Arena Paolo Cecinato Andrea Lisotti Federica Buonfiglioli Claudio Calvanese Giuseppe Grande Marco Montagnani Francesco Azzaroli Giuseppe Mazzella 

机构地区：[1]Department of Medical and Surgical Science-DIMEC, University of Bologna, S.Orsola-Malpighi Hospital

出　　处：《World Journal of Hepatology》2015年第12期1718-1722,共5页世界肝病学杂志（英文版）（电子版）

摘　　要：Mild to moderate autoimmune thrombocytopenia(AITP) is a common finding in patients receiving interferonbased 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 interferonbased 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 interferonbased 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 alsoafter discontinuation.Mild to moderate autoimmune thrombocytopenia （AITP）is a common finding in patients receiving interferonbasedantiviral treatment, due to bone marrow suppression.Here we report the case of a patient with chronicgenotype 1b hepatitis C virus （HCV） infection treatedwith pegylated-interferon alpha-2a, ribavirin andtelaprevir for 24 wk; the patient developed severe AITPthree weeks after treatment withdrawal. We performeda systematic literature search in order to reviewall published cases of AITP related to HCV antiviraltreatment. To our knowledge, this is the second case ofAITP observed after antiviral treatment withdrawal. Inmost published cases AITP occurred during treatment;in fact, among 24 cases of AITP related to interferonbasedantiviral treatment, only one occurred afterdiscontinuation. Early diagnosis of AITP is a key factor inorder to achieve an early interferon discontinuation; inthe era of new direct antiviral agents those patients haveto be considered for interferon-free treatment regimens.Prompt prescription of immuno-suppressant treatment（i.e. , corticosteroids, immunoglobulin infusion and evenrituximab for unresponsive cases） leads to favourableprognosis in most of cases. Physicians using interferonbasedtreatments should be aware that AITP can occurboth during and after treatment, specially in the new eraof interferon-free antiviral treatment. Finally, in the caseof suspected AITP, presence of anti-platelet antibodiesshould be checked not only during treatment but also after discontinuation.

关 键 词：AUTOIMMUNE THROMBOCYTOPENIA Pegylatedinterferon Chronic HEPATITIS C VIRAL HEPATITIS Antiplateletantibody 

分 类 号：R558.2[医药卫生—血液循环系统疾病]