Hepatic Sarcoidosis Associated with Pegylated Interferon Alfa Therapy for Chronic Hepatitis C—Case Report and Review of Literature

Abstract

An estimated 3.2 million people have chronic hepatitis C (HCV) infection in the United States [1]. Treatment with pegylated alfa interferon and ribavirin for 24–48 weeks is the standard treatment for HCV with sustained virological response rates of over 50% [2–4]. Interferon alfa has immunomodulatory actions and has been implicated in the development of several autoimmune diseases [5]. Interferon-induced sarcoidosis (IIS) has been reported previously with the use of standard interferon alfa but there is limited data with pegylated interferon, with a few reports of cutaneous and pulmonary sarcoidosis occurring [5–16]. There are no published reports of hepatic sarcoidosis developing with pegylated interferon alfa use. We report a case of the development of hepatic sarcoidosis during treatment with pegylated interferon alfa 2b and ribavirin with pathological confirmation of granulomatous inflammation on liver biopsy and an elevated serum angiotensin converting enzyme (ACE) level. The case is important in that it illustrates that elevation of liver enzymes during treatment, particularly if associated with a decline in HCV viral load, should be concerning for another process and lead to a liver biopsy. Case Report