Pegylated interferon, ribavirin, and frequent supportive therapy with growth factors. Which pathogenesis for a severe psoriasis complicating the treatment of chronic HCV hepatitis?

Abstract

One of the most effective treatments for HCV and HBV infection is the combination of pegylated IFN-alpha and ribavirin. However, both IFN-alpha and ribavirin can induce hematologic toxicity, which can compromise treatment adherence and dose maintenance and could, therefore, influence outcomes. Hematopoietic growth factors (e.g. filgrastim) can provide significant benefits in the treatment of this toxicity, but they can also exacerbate cutaneous psoriasis. We report a case of a 54-year-old woman with chronic, progressive hepatitis C, treated with long-term pegylated interferon plus ribavirin, associated with multiple cycles of filgrastim for a severe, recurring granulocytopenia. The patient developed an extensive and severe psoriasis, which improved only after specific treatment with cyclosporin. The case highlights the importance of treatment adherence and dose maintenance to obtain a sustained virologic response, and underlines the difficulties of the management of this disease when side effects, such as hematologic toxicity and psoriasis, are present.