Journal of Pediatric Gastroenterology & Nutrition:
Letters to the Editor
Acute Life-threatening Event With Peginterferon α-2b in a Child With Chronic Hepatitis C
Bhat, Abdus S.; Varma, Sharat; Chaturvedi, Mona K.
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
To the Editor:
A 12-year-old boy from north India with a history of ventricular septal defect repair at 1 year of age was diagnosed as having chronic hepatitis C, genotype 3. After initial evaluation and a liver biopsy, he started taking pegylated interferon α-2b (PEGIFNα-2b) at a dose of 60 μg/m2 subcutaneously weekly and ribavarin at a dose of 15 mg · kg−1 · day−1(1,2). At 12 weeks of therapy, his hepatitis C virus RNA was below detectable limits but had again appeared at 24 weeks, so he was continued on the said treatment. He was tolerating the treatment well; however, in the 28th week of the PEGIFNα-2b, after 3 hours of the injection, while playing in the field, he fell unconscious and was brought to the hospital after 15 minutes in cardiorespiratory arrest. He was revived after cardiopulmonary resuscitation. There were no features of acute hypersensitivity; electrolytes, calcium, and blood sugar were normal. Computed tomography scan of brain was normal. His electrocardiogram taken later on was normal. After 1 month of the event, he is still in the hospital, on ventilator. Magnetic resonance imaging of brain showed features of severe hypoxia.
We consider this whole event as a possible adverse effect of PEGIFN administration, although we do not have clarity about the nature of the terminal event, possibly seizure or arrhythmia. Seizures have been reported with PEGIFN in adults, but all of them had comorbidities to explain seizures (3). Arrhythmias have not been reported with PEGIFNα in children and it has been used successfully in patients with coexisting heart disease (4). No deaths have been reported in children.
1. Wirth S, Ribes-Koninckx C, Calzado MA, et al. High sustained virologic response rates in children with chronic hepatitis C receiving peginterferon alfa-2b plus ribavirin. J Hepatol 2010; 52:501–507.
2. Wirth S, Pieper-Boustani H, Lang T, et al. Peginterferon alfa-2b plus ribavirin treatment in children and adolescents with chronic hepatitis C. Hepatology 2005; 41:1013–1018.
3. Ahmed F, Jacobson IM, Herrera JL, et al. Seizures during pegylated interferon and ribavirin therapy for chronic Hepatitis C: observations from the WIN-R trial. J Clin Gastroenterol 2011; 45:286–292.
4. Durante-Mangoni E, Iossa D, Pinto D, et al. Safety and efficacy of peginterferon alpha plus ribavirin in patients with chronic hepatitis C and coexisting heart disease. Dig Liver Dis 2011; 43:411–415.
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