Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jan 14, 2008; 14(2): 318-321
Published online Jan 14, 2008. doi: 10.3748/wjg.14.318
Acute inflammatory demyelinating polyneuropathy associated with pegylated interferon α 2a therapy for chronic hepatitis C virus infection
Vijay Khiani, Thomas Kelly, Adeel Shibli, Donald Jensen, Smruti R Mohanty
Vijay Khiani, Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
Thomas Kelly, Department of Neurology, The University of Chicago, Chicago, IL, United States
Adeel Shibli, Department of Medicine, Weiss Memorial Hospital, Chicago, IL, United States
Donald Jensen, Smruti R Mohanty, Department of Medicine, Center for Liver Diseases, The University of Chicago, Chicago, IL, United States
Correspondence to: Smruti R Mohanty, MD, MS, Assistant Professor of Medicine, Department of Medicine, Section of Gastroenterology, Center for Liver Diseases, The University of Chicago, 5841 S. Maryland Avenue, MC 7120, Chicago, IL 60637-1463, United States.
Telephone: +1-773-7022394
Fax: +1-773-8341288
Received: April 2, 2007
Revised: October 25, 2007
Published online: January 14, 2008

The combination of pegylated interferon (Peg-IFN) and ribavirin is the standard of care for chronic hepatitis C virus (HCV) infection treatment. In general, common side effects related to this combination therapy are mild and are very well tolerated. However, peripheral neuropathy including demyelinating polyneuropathy related to Peg-IFN is extremely rare. We present the first case of an acute inflammatory demyelinating polyneuropathy (AIDP) associated with Peg-IFN-α 2a (Pegasys) after 16 wk of a combination therapy with Pegasys and ribavirin in a 65-year-old woman with chronic HCV infection. She developed tingling, numbness, and weakness of her upper and lower extremities and was hospitalized for acute neurological deficits. Her clinical course, neurological findings, an electromyogram (EMG), nerve conductions studies (NCS), muscle biopsy, and a sural nerve biopsy were all consistent with AIDP likely related to Pegasys use. The patient recovered completely with the use of intravenous immunoglobulin (IVIG) including physical therapy and neurological rehabilitation. It is very important that gastroenterologists and/or hepatologists recognize this rare neurological complication related to Peg-IFN treatment very early, since it requires a prompt discontinuation of therapy including an immediate referral to a neurologist for the confirmation of diagnosis, management, and the prevention of long-term neurological deficits.

Keywords: Neuropathy, Pegylated interferon, Pegasys