[Autoimmunization induced by interferon alpha therapy in chronic hepatitis C]. / Auto-immunisation induite par l'interféron alpha dans un contexte d'hépatite virale C chronique.

We report the case of a 56 year-old woman with post-transfusion chronic hepatitis C who presented with a severe ALT flare up associated with a rapid progression of liver fibrosis during interferon alpha 2b therapy. Several hypotheses were considered to explain the etiology of this ALT flare: there was no viral super infection by other hepatotropic viruses, no toxic hepatitis, no metabolic disease, and no other specific liver diseases could be identified. HLA typing showed a specific profile A1 B8 DR3 (risk factor of auto-immunization during interferon alpha therapy) with antinuclear antibodies and anti smooth muscle antibodies. This case suggests that auto-immunization induced by interferon alpha should be investigated in case of ALT flare that is not followed by an HCV breakthrough.

[Early treatment of acute hepatitis C with interferon alpha-2b or interferon alpha-2b plus ribavirin: study of sixteen patients]. / Etude de seize cas d'hépatite C aiguë. Essai de traitement précoce par l'interféron alpha- 2b ou interféron alpha- 2b et ribavirine.

AIM OF THE STUDY: To assess the mode of transmission and the efficacy of antiviral therapy in the outcome of treated and untreated patients with acute hepatitis C. PATIENTS AND METHODS: From December 1995 to January 2001, 16 consecutive patients and their response to therapy were studied, including clinical, biochemical, virological and histological data. RESULTS: Hepatitis C virus (HCV) exposure was IVDU (38%), needle-stick injury (19%), medical procedure (6%), piercing (6%), suspected sexual contact (19%), and unknown in 2. Among 13 patients treated for acute hepatitis C, all 12 patients who completed therapy had a biochemical and virological sustained response for more than 15 months (range: 4-36 months) after stopping therapy. Therapy was tolerated in all but one patient, who stopped after 10 weeks because of side effects. Duration of treatment, type of interferon and combination with ribavirin did not modify the response to treatment. CONCLUSION: These results suggest that early intervention with interferon alpha is effective in preventing the progression of acute HCV infection to chronic hepatitis in most patients regardless of duration, type of interferon, or combination with ribavirin.

Is scintigraphic double-track appearance a sign of severe acute episodes of ulcerative colitis?

AIM: In comparison to endoscopy, clinical and biological criteria are less predictive of severity in attacks of ulcerative colitis (UC). Our aim was to assess the value of the double-track scintigraphic appearance in the assessment of the severity of acute UC by comparing it to endoscopic criteria. PATIENTS AND METHODS: We reviewed medical records of 52 patients hospitalized for an acute attack of UC, who had undergone within 48 hours of presentation both a technetium 99m hexamethyl propylene amine oxime (99mTc-HMPAO) granulocyte scintigraphy and endoscopic examination (colonoscopy: n=20; rectosigmoidoscopy: n=32). RESULTS: Taking into account the colonic segments examined together with both methods in the same patient or results obtained with colonoscopies, there was an excellent agreement between the double-track scintigraphic appearance and endoscopic criteria of severity. CONCLUSION: In patients with previously diagnosed UC, 99mTc-HMPAO granulocyte scintigraphy when available may replace endoscopic examination to assess the severity of attacks.

[Induced interstitial pneumonitis: role of pegylated interferon alpha 2b]. / Forme pegylée de l'interféron alpha 2b et pneumopathies interstitielles diffuses.

Pulmonary complications of alpha interferon are rare. We report two cases of lung complications in liver transplantation patients for HCV related cirrhosis. After switching from interferon alpha to pegylated interferon alpha 2b, one patient developed a BOOP (Bronchiolitis Obliterans Organizing Pneumonia) and the other severe interstitial pneumonitis. We discuss the causes of these rare pulmonary alpha-interferon induced complications and the different way to suggest that the pegylated interferon alpha 2b could be related to the risk of pulmonary toxicity of this treatment.