RESUMEN
BACKGROUND: In patients with hepatitis C virus (HCV) and malignant lymphoma, hepatitis C flare during R-CHOP can result in discontinuation of treatment. However, appropriate therapeutic strategies for managing hepatitis C flare during R-CHOP have not been established, and this issue is complicated by conflicting results regarding the use of direct-acting antivirals in patients with uncontrolled malignancies. CASE PRESENTATION: We report the first case of effective and safe treatment with on-demand 8-week glecaprevir and pibrentasvir for hepatitis C flare during R-CHOP in a patient with diffuse large B-cell lymphoma (DLBCL). The patient completed five additional courses of R-CHOP without hepatic toxicity. A complete response of DLBCL and a sustained virological response were observed at 24 weeks after glecaprevir and pibrentasvir completion. CONCLUSION: On-demand, direct-acting antivirals could be a novel strategy for managing hepatitis C flare during R-CHOP.
Asunto(s)
Ácidos Aminoisobutíricos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Antivirales/administración & dosificación , Bencimidazoles/administración & dosificación , Ciclopropanos/administración & dosificación , Hepacivirus/genética , Hepatitis C/complicaciones , Hepatitis C/tratamiento farmacológico , Lactamas Macrocíclicas/administración & dosificación , Leucina/análogos & derivados , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Prolina/análogos & derivados , Quinoxalinas/administración & dosificación , Sulfonamidas/administración & dosificación , Ciclofosfamida/uso terapéutico , Doxorrubicina/uso terapéutico , Genotipo , Humanos , Leucina/administración & dosificación , Masculino , Persona de Mediana Edad , Prednisona/uso terapéutico , Prolina/administración & dosificación , Pirrolidinas , ARN Viral/sangre , ARN Viral/genética , Rituximab/uso terapéutico , Respuesta Virológica Sostenida , Vincristina/uso terapéutico , Carga Viral/efectos de los fármacosRESUMEN
A 73-year-old woman with a history of diarrhea for one year and other various symptoms was admitted to our hospital. Gastrointestinal endoscopy that included enteroscopy with multiple biopsies was performed. However, no significant findings were observed. Electrocardiography showed low voltage in all limb leads, and an echocardiogram showed thickened cardiac walls with granular sparkling pattern. A myocardial biopsy revealed amyloidosis, and a bone marrow biopsy showed multiple myeloma. This case suggests that we should suspect the possibility of amyloidosis in a patient with diarrhea and various symptoms involving multiple organ systems. Additionally, electrocardiograms and echocardiograms should be performed even when gastrointestinal biopsies reveal negative results.