Abstract
BackgroundUlcerative colitis is a lifelong, immunologically mediated disease. Direct-acting antivirals (DAAs) are now available for the treatment of chronic hepatitis C virus (HCV) infection. An interferon-free regimen appears useful, safe and effective for many patients for whom interferon-based treatment is contraindicated.Case presentationWe studied a 56-year-old treatment-naïve Japanese man with chronic HCV genotype 2b infection who had ulcerative colitis. This patient was treated with sofosbuvir and ribavirin for 12 weeks. During treatment, diarrhoea and bloody faeces were frequent. After ribavirin was reduced to 400 mg daily, these symptoms decreased. Finally, the patient achieved a sustained virologic response 12 weeks after the stoppage of the treatment.ConclusionClinicians should pay careful attention to the ribavirin dose in the treatment of certain HCV patients with inflammatory bowel disease who are receiving sofosbuvir plus ribavirin.
Highlights
Ulcerative colitis is a lifelong, immunologically mediated disease
Because the prevalences of hepatitis B virus (HBV) and hepatitis C virus (HCV) are higher in Asian countries, including
The patient drank alcohol (21 g daily) for 20 years; had a medical history of hypertension, IgA nephropathy, type 2 diabetes mellitus and dilated cardiomyopathy; and took several medications for these diseases. His ulcerative colitis was relatively well-controlled with oral sarazopyridine (4500 mg daily) and a sarazopyridine suppository (300 mg daily)
Summary
Inflammatory bowel disease (IBD), which comprises ulcerative colitis and Crohn’s disease, is a chronic immunologically mediated disease [1]. The patient drank alcohol (21 g daily) for 20 years; had a medical history of hypertension, IgA nephropathy, type 2 diabetes mellitus and dilated cardiomyopathy; and took several medications for these diseases His ulcerative colitis was relatively well-controlled with oral sarazopyridine (4500 mg daily) and a sarazopyridine suppository (300 mg daily). As the patient’s HCV RNA became negative and he improved to having 5 loose bowel movements per day by week 4 [WBC, 8600/μL; hemoglobin, 14.3 g/dL; AST, 19 IU/L; and ALT, 19 IU/L], the dose of ribavirin was increased to 800 mg daily. By week 7, the patient was having up to 20 loose bowel movements per day, with small amounts of blood, and the dose of ribavirin was decreased to 400 mg daily [WBC, 8200/μL; hemoglobin, 14.7 g/dL; CRP 0.1 mg/dL; AST, 19 IU/L; and ALT, 17 IU/L]. The patient did not complain of abdominal pain or fever during treatment
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