Interstitial pneumonitis in a patient treated with alpha-interferon and ribavirin for hepatitis C infection

Hepatitis C is a common infection with worldwide prevalence. It has a varia ble course and can lead to chronic hepatitis, cirrhosis and hepatocellular carcinoma. Until recently a-interferon (IFN-alpha) was the only effective t reatment available. Combination therapy with IFN-alpha and ribavirin has be en found to be more efficacious than IFN-alpha alone. Various side effects have been ascribed to interferon, such as arthralgias, myalgias, fatigue, a nd gastrointestinal and neuropsychiatric symptoms. Interstitial pneumonitis is a rare but known complication of IFN-alpha when given at a high dosage of 6 to 10 million units per day. Ribavirin is associated with dose-depende nt hemolytic anemia, cough, dyspnea, rash, depression, and dyspepsia, altho ugh a potential role in interferon-induced interstitial pneumonitis has not been described. We describe a patient with an excellent clinical response of chronic hepatitis C to combination therapy with IFN-alpha at a dosage of 3 million units per day and ribavirin. The patient developed interstitial pneumonitis that resolved after discontinuation of IFN-alpha and ribavirin. Given that interstitial pneumonitis has previously been reported with high -dose IFN-alpha, this case suggests that this complication may occur with l ower dosages of IFN-alpha, although a potential role for ribavirin in this disorder at present remains speculative.