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Myasthenia Crisis Induced by Pegylated-Interferon in Patient With Chronic Hepatitis C: A Case Report.

Authors
 Su Jung Baik  ;  Tae Hun Kim  ;  Hye In Kim  ;  Jeong Yeon Rhie 
Citation
 MEDICINE, Vol.95(21) : 3782, 2016 
Journal Title
 MEDICINE 
ISSN
 0025-7974 
Issue Date
2016
MeSH
Adrenal Cortex Hormones/administration & dosage ; Antiviral Agents/adverse effects* ; Antiviral Agents/therapeutic use ; Cholinesterase Inhibitors/administration & dosage ; Drug Therapy, Combination ; Hepatitis C, Chronic/drug therapy* ; Humans ; Interferon-alpha/adverse effects* ; Interferon-alpha/therapeutic use ; Male ; Middle Aged ; Myasthenia Gravis/chemically induced* ; Polyethylene Glycols ; Respiration, Artificial ; Ribavirin/therapeutic use ; Thymoma/diagnosis ; Thymoma/surgery ; Thymus Neoplasms/diagnosis ; Thymus Neoplasms/surgery
Abstract
Myasthenia gravis is occasionally associated with thymoma that needs surgical resection and may progress to severe respiratory failure. We experienced a rare case of myasthenia crisis during antiviral therapy for chronic hepatitis C, in whom mediastinal thymoma was discovered and successfully managed with surgical thymectomy and meticulous medical care.A 47-year-old-male patient complained of sudden diplopia 1 week after stopping 11-week administration of pegylated-interferon and ribavirin for chronic hepatitis C. Ophthalmologic examinations revealed ptosis on the right eyelid and restricted right eye movement. Myasthenia gravis was confirmed by positive repetitive nerve stimulation test and positive serum antiacetylcholine receptor antibody test, and mediastinal thymoma was found on chest CT scan. The ocular myasthenia gravis progressed to respiratory failure even after discontinuing antiviral treatment but eventually recovered with thymectomy, anticholinesterase administration, steroid pulse therapy, and prolonged ventilator care. We describe the clinical features of this life-threatening complication of interferon treatment along with previous myasthenia crisis cases by interferon for chronic hepatitis C.In patients with chronic hepatitis C who is going to receive interferon-based antiviral treatment, physicians need to keep in mind the potential life-threatening manifestations of myasthenia gravis before and during antiviral treatment especially when patients complain of muscular weakness and easy fatigability.
Files in This Item:
T201601758.pdf Download
DOI
10.1097/MD.0000000000003782
Appears in Collections:
7. Others (기타) > Gangnam Severance Hospital (강남세브란스병원) > 1. Journal Papers
Yonsei Authors
Baik, Su Jung(백수정) ORCID logo https://orcid.org/0000-0002-3790-7701
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146939
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