Methods: Case report.
Results: 32 years old female was referred because of fluctuating elevations of aminotransferases (AT) (4-19-fold normal) known last six months. She had positive HCV-RNA by RT-PCR an untypable genotype. Liver biopsy revealed chronic active hepatitis grade 2, stage 2. She also had Hashimoto´s thyroiditis with high titres of antithyroid antibodies. After 12 weeks of treatment with Intron A 3MU TIW and RBV 1000mg/d, HCV RNA was negative and AT fluctuated between normal and 2-fold normal. One week after completing 48 weeks of treatment, AT showed 11-fold increase, but HCV remained negative. Indirect immunofluorescence became positive for ASMA (3+) and ANA (4+). A repeated liver biopsy showed no improvement. A therapeutic trial with RBV was started and within 11 weeks of this treatment her symptoms markedly improved and AT decreased to 2-fold. Unfortunately, cessation of RBV resulted in immediate reversion of symptoms and elevation of AT to its previous state. After restarting RBV therapy no response was observed within 2 weeks and the treatment was stopped. She was then put on prednisone 30mg/d and azathioprine 50mg/d. Within 6 weeks her symptoms resolved and AT and IgG became completely normal. The patient remains in remission with prednisone 5 mg and azathioprine 50mg/d. A re-evaluation of the primary diagnosis of hepatitis C was warranted because of unusually high AT activity and repeatedly negative anti-HCV using a third generation assay.
Conclusions: This case may provide support for the hypothesis that RBV may dampen autoimmune reaction induced by IFN alpha and potentiate its anti-inflammatory effects.