Choi Catherine, Botros Youssef, Shah Jamil, Xue Pei, Jones Anja, Galan Mark, Olivo Raquel, Niazi Mumtaz, Paterno Flavio, Guarrera James, Pyrsopoulos Nikolaos T
Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
Division of Gastroenterology, St. Joseph's University Medical Center, Paterson, NJ, USA.
J Clin Transl Hepatol. 2020 Dec 28;8(4):459-462. doi: 10.14218/JCTH.2020.00062. Epub 2020 Oct 10.
Direct-acting antiviral (DAA) therapy is often well-tolerated, and adverse events from DAA therapy are uncommon. We report a case of a woman who underwent orthotopic liver transplant for chronic hepatitis C infection and later developed alloimmune hepatitis shortly after starting DAA therapy for recurrent hepatitis C infection. The patient developed acute alloimmune hepatitis approximately 2 weeks after starting treatment with sofosbuvir, velpatasvir, and voxilaprevir. This case report proposes a dysregulation of immune surveillance due to the DAA stimulation of host immunity and rapid elimination of hepatitis C viral load as a precipitating factor for the alloimmune process, leading to alloimmune hepatitis in a post-transplant patient who starts on DAA.
直接抗病毒（DAA）疗法通常耐受性良好，且DAA疗法引起的不良事件并不常见。我们报告一例女性病例，该患者因慢性丙型肝炎感染接受原位肝移植，后来在开始接受DAA疗法治疗复发性丙型肝炎感染后不久发生了同种免疫性肝炎。该患者在开始使用索磷布韦、维帕他韦和伏西瑞韦治疗后约2周出现急性同种免疫性肝炎。本病例报告提出，由于DAA刺激宿主免疫以及丙型肝炎病毒载量的快速清除导致免疫监视失调，这是同种免疫过程的一个促发因素，导致开始使用DAA的移植后患者发生同种免疫性肝炎。
