Trien Remi, Cooper Chad J, Paez David, Colon Edgardo, Ajmal Shajeea, Salameh Hasan
Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
Am J Case Rep. 2014 May 28;15:235-8. doi: 10.12659/AJCR.890180. eCollection 2014.
Female, 43 FINAL DIAGNOSIS: -
Diarrhea • generalized weakness • headache • lightheadedness • nausea • rash • short of breath • vomiting
Rare diseae.
IFN-alpha-2b in combination with ribavirin is now the standard of care for the treatment of hepatitis C. Sarcoidosis is a chronic multisystem granulomatous disorder characterized by noncaseating granulomas in the involved organs. The pathologic hallmark of sarcoidosis is the presence of noncaseating granulomas in the interstitium that typically involve the lymphatics.
A 43-year-old woman presented to our care with 2-week history of nausea, vomiting, diarrhea, shortness of breath, migraine headache, maculopapular rash, generalized weakness, and lightheadedness. She had been treated for hepatitis C with telaprevir, ribavirin, and interferon-alpha-2b for 6 months. Chest radiograph showed bilateral diffuse prominence of bronchovascular markings. CT of the chest revealed bilateral diffuse centrilobular nodules with associated intralobular septal thickening, thickening of the central peribronchovascular interstitium, nodularity of the major fissures, and mediastinal lymphadenopathy. These findings were suspicious for atypical pulmonary sarcoidosis, possibly interferon-induced. The pathology of the mediastinal lymph node biopsy revealed noncaseating granulomatous inflammation consistent with the diagnosis of pulmonary sarcoidosis. Pathology of the skin punch biopsy showed giant-cell granulomatous inflammation without necrosis. The patient was started on prednisone 40 mg daily with a steroid tapering course for 8 weeks.
The management of IFN-induced sarcoidosis includes the discontinuation of IFN therapy with or without the administration of systemic corticosteroids. With the increasing prevalence of HCV in the United States, it is likely that more IFN-alpha-induced sarcoidosis will be encountered by clinicians.
女性，43岁 最终诊断：-
腹泻、全身无力、头痛、头晕、恶心、皮疹、呼吸急促、呕吐
罕见疾病
干扰素-α-2b联合利巴韦林目前是治疗丙型肝炎的标准疗法。结节病是一种慢性多系统肉芽肿性疾病，其特征是受累器官出现非干酪样肉芽肿。结节病的病理标志是间质中存在非干酪样肉芽肿，通常累及淋巴管。
一名43岁女性因恶心、呕吐、腹泻、呼吸急促、偏头痛、斑丘疹、全身无力和头晕等症状前来就诊，病史为2周。她曾接受特拉匹韦、利巴韦林和干扰素-α-2b治疗丙型肝炎6个月。胸部X线片显示双侧支气管血管纹理增粗。胸部CT显示双侧弥漫性小叶中心结节，伴有小叶内间隔增厚、中央支气管血管周围间质增厚、主裂结节形成以及纵隔淋巴结肿大。这些表现怀疑为非典型肺结节病，可能是干扰素诱导的。纵隔淋巴结活检病理显示非干酪样肉芽肿性炎症，符合肺结节病的诊断。皮肤穿刺活检病理显示巨细胞肉芽肿性炎症，无坏死。患者开始每日服用40毫克泼尼松，并进行为期8周的激素减量疗程。
干扰素诱导的结节病的治疗包括停用干扰素治疗，可联合或不联合使用全身性皮质类固醇。随着美国丙型肝炎病毒感染率的上升，临床医生可能会遇到更多由干扰素-α诱导的结节病。
