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Review
, 18 (31), 4233-6

Ischemic Colitis During Interferon-Ribavirin Therapy for Chronic Hepatitis C: A Case Report

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Review

Ischemic Colitis During Interferon-Ribavirin Therapy for Chronic Hepatitis C: A Case Report

Su Jung Baik et al. World J Gastroenterol.

Abstract

Ischemic colitis is a rare complication of interferon administration. Only 9 cases in 6 reports have been described to-date. This report describes a case of ischemic colitis during pegylated interferon and ribavirin treatment for chronic hepatitis C, and includes a review of the relevant literature. A 48-year-old woman was treated with pegylated interferon α-2a and ribavirin for chronic hepatitis C, genotype Ib. After 19 wk of treatment, the patient complained of severe afebrile abdominal pain with hematochezia. Vital signs were stable and serum white blood cell count was within the normal range. Abdominal computed tomography showed diffuse colonic wall thickening from the splenic flexure to the proximal sigmoid colon, which is the most vulnerable area for the development of ischemic colitis. Colonoscopy revealed an acute mucosal hyperemic change, with edema and ulcerations extending from the proximal descending colon to the sigmoid colon. Colonic mucosal biopsy revealed acute exudative colitis. Polymerase chain reaction and culture for Mycobacterium tuberculosis were negative and the cultures for cytomegalovirus, Salmonella and Shigella species were negative. After discontinuation of interferon and ribavirin therapy, abdominal pain and hematochezia subsided and, following colonoscopy showed improvement of the mucosal ulcerations. Ischemic colitis cases during interferon therapy in patients with chronic hepatitis C reported so far have all involved the descending colon. Ischemic colitis is a rarely encountered complication of interferon administration in patients with chronic hepatitis C and should be considered when a patient complains of abdominal pain and hematochezia.

Keywords: Hepatitis C; Interferon; Ischemia.

Figures

Figure 1
Figure 1
Colonoscopy images and pathology. A: Mucosal hyperemic change with edema, erosion, and ulcerations and hemorrhagic friable mucosa on the sigmoid colon; B: Segmental ulceration was seen on the proximal descending colon; C: Pathological examination of the descending colon showed acute exudative colitis. Epithelial detachment was observed (hematoxylin and eosin stain, × 40).
Figure 2
Figure 2
Abdominal computed tomography. A: Circumferentially layered wall thickening and pericolic fat infiltration at the descending colon (arrow); B: Circumferential wall thickening and pericolic fat infiltration at the proximal sigmoid colon (arrows).

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