Development and management of systemic lupus erythematosus in an HIV-infected man with hepatitis C and B co-infection following interferon therapy: a case report.
AuthorAbbott, IJ; Chang, CC; Skinner, MJ; Street, A; Perry, G; McLean, C; Wright, EJ; Cameron, PU
Source TitleJournal of Medical Case Reports
PublisherSpringer Science and Business Media LLC
AffiliationFlorey Department of Neuroscience and Mental Health
Document TypeJournal Article
CitationsAbbott, I. J., Chang, C. C., Skinner, M. J., Street, A., Perry, G., McLean, C., Wright, E. J. & Cameron, P. U. (2009). Development and management of systemic lupus erythematosus in an HIV-infected man with hepatitis C and B co-infection following interferon therapy: a case report.. J Med Case Rep, 3 (1), pp.7289-. https://doi.org/10.4076/1752-1947-3-7289.
Access StatusOpen Access
Open Access at PMChttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726516
INTRODUCTION: The association of human immunodeficiency virus and immune dysfunction leading to development of autoimmune markers is well described, but human immunodeficiency virus infection is relatively protective for the development of systemic lupus erythematosus. In contrast, development of systemic lupus erythematosus with hepatitis C and with interferon therapy is well described in a number of case reports. We here describe the first case of systemic lupus erythematosus developing in a man infected with human immunodeficiency virus, hepatitis C and hepatitis B co-infection where the onset seems to have been temporally related to interferon therapy. CASE PRESENTATION: We report the occurrence of systemic lupus erythematosus complicating interferon-alpha therapy for hepatitis C in a 47-year-old asplenic male with haemophilia co-infected with human immunodeficiency virus and hepatitis B. He presented with a truncal rash, abdominal pains and headache and later developed grade IV lupus nephritis requiring haemodialysis, mycophenolate mofetil and steroid therapy. We were able to successfully withdraw dialysis and mycophenolate while maintaining stable renal function. CONCLUSION: Interferon-alpha is critical in antiviral immunity against hepatitis C but also acts as a pathogenic mediator for systemic lupus erythematosus, a condition associated with activation of plasmacytoid dendritic cells that are depleted in human immunodeficiency virus infection. The occurrence of auto-antibodies and lupus-like features in the coinfections with hepatitis C require careful assessment. Immunosuppressant therapy for lupus risks exacerbating underlying infections in patients with concurrent human immunodeficiency virus, hepatitis B and C.
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