ABSTRACT
Pegylated interferon alfa-2b is a formulation of recombinant human interferon conjugated with polyethylene glycol. Compared with standard interferon alfa injections, this preparation has a longer half-life allowing for once-weekly injections and superior antiviral efficacy in the treatment of hepatitis C when used in combination with ribavirin. Cutaneous side effects caused by interferon are well known. Cutaneous necrosis as a result of interferon alfa is an infrequent complication with unknown pathogenesis, in which a cutaneous local immune-mediated inflammatory process might be involved. We report 5 patients (3 patients with chronic hepatitis C treated with pegylated interferon alfa-2b in association with oral ribavirin and two patients with chronic myelocytic leukemia) who developed local cutaneous reactions at sites of injection after the administration of weekly subcutaneous injections of pegylated interferon alfa-2b at different doses. The ulcers slowly healed with local therapy, but two patients required dose modification of the pegylated interferon alfa-2b and one patient required treatment withdrawal. We review the literature on previously reported cases of cutaneous necrosis after injection of standard interferon alfa or pegylated interferon alfa-2b and discuss the different pathophysiologic mechanisms that might be involved.
Subject(s)
Antiviral Agents/adverse effects , Interferon-alpha/adverse effects , Skin Ulcer/chemically induced , Skin/pathology , Aged , Antiviral Agents/administration & dosage , Female , Hepatitis C, Chronic/drug therapy , Humans , Injections , Interferon alpha-2 , Interferon-alpha/administration & dosage , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Male , Middle Aged , Necrosis/chemically induced , Polyethylene Glycols , Recombinant Proteins , Skin Ulcer/pathologyABSTRACT
Los defectos de repleción más comunes en el Sistema Biliar son los cálculos; que pueden ser únicos, múltiples, grandes o pequeños, sin embargo, la infestación por Ascaris puede ir acompañada de la migración de un vermes al colédoco donde causa un defecto de repleción lineal largo y grueso. Presentamos el caso de una Ascaridiasis Biliar en una paciente femenina de 41 años, colecistectomizada y con antecedente de CPRE, con clínica de obstrucción biliar (post-colecistectomía), siendo utilizado como método diagnóstico y de seguimiento ecosonograma y CPRE. Se administró tratamiento sintomático y antihelmíntico, encontrando una evolución clínica, por CPRE y ecosonograma satisfactorio. Proponemos CPRE sólo en casos donde haya obstrución y/o Pancreatitis Biliar como método ideal aplicable en cualquier momento de la enfermedad, rápido, seguro para su diagnóstico seguimiento y tratamiento definitivo. Se revisan los casos en nuestro centro hospitalario desde 1990-1996 y de la Literatura Mundial y Nacional
