Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Lupus activation with cerebritis following pegylated interferon in a hemodialysis patient

Abstract

Background. A 20-year-old female patient with chronic hepatitis C virus infection and end-stage renal disease due to systemic lupus erythematosus was admitted to hospital with fever, pain in the abdomen, seizures and an alteration of consciousness. The patient was on maintenance dialysis and was receiving pegylated interferon monotherapy for her chronic hepatitis C virus infection.

Investigations. Physical examination, laboratory tests including complete blood count and measurement of serum electrolyte levels, CT scans of the head and abdomen, MRI of the brain, microscopic examination of the cerebrospinal fluid, chest X-ray, echocardiography and measurement of C3 complement and anti-double-stranded DNA antibody levels.

Diagnosis. Activation of systemic lupus erythematosus with cerebritis following pegylated interferon therapy.

Management. Intravenous fluid, intermittent oxygen, intravenous diphenylhydantoin, intravenous pulse methylprednisolone 500 mg for 3 days followed by 40 mg per day of oral prednisolone, and temporary withdrawal of pegylated interferon.

Your institute does not have access to this article

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1: CT scan of the abdomen on hospital admission showing jejunal wall thickening (arrow) with features of ileus and mild ascites.
Figure 2: Chest X-ray showing cardiomegaly on hospital admission.

References

  1. Ishak, K. et al. Histological grading and staging of chronic hepatitis. J. Hepatol. 22, 696–699 (1995).

    CAS  Article  Google Scholar 

  2. Wilson, L. E., Widman, D., Dikman, S. H. & Gorevic, P. D. Autoimmune disease complicating antiviral therapy for hepatitis C virus infection. Semin. Arthritis Rheum. 32, 163–173 (2002).

    Article  Google Scholar 

  3. Ho, V., McLean, A. & Terry, S. Severe systemic lupus erythematosus induced by antiviral treatment for hepatitis C. J. Clin. Rheumatol. 14, 166–168 (2008).

    Article  Google Scholar 

  4. Niewold, T. B. & Swedler, W. I. Systemic lupus erythematosus arising during interferon-α therapy for cryoglobulinemic vasculitis associated with hepatitis C. Clin. Rheumatol. 24, 178–181 (2005).

    Article  Google Scholar 

  5. Goyal, H. K. et al. Interferon-induced lupus nephritis in a patient with chronic myeloid leukemia. Leuk. Lymphoma 46, 481–482 (2005).

    Article  Google Scholar 

  6. Pouthier, D., Theissen, F. & Humbel, R. L. Lupus syndrome, hypothyroidism and bullous skin lesions after interferon-α therapy for hepatitis C in a haemodialysis patient. Nephrol. Dial. Transpl. 17, 174 (2002).

    Article  Google Scholar 

  7. Gladman, D. D. & Urowitz, M. B. Systemic lupus erythematosus: clinical and laboratory features. In Primer on the Rheumatic Diseases 11th edn (Eds Klippel, J. H. et al.) 251–257 (Arthritis Foundation, Atlanta, 1997).

    Google Scholar 

  8. Chow, K. M. et al. Nonconvulsive status epilepticus in peritoneal dialysis patients. Am. J. Kidney Dis. 38, 400–405 (2001).

    CAS  Article  Google Scholar 

  9. Beccari, M. Seizures in dialysis patients treated with recombinant erythropoietin. Review of the literature and guidelines for prevention. Int. J. Artif. Organs 17, 5–13 (1994).

    CAS  Article  Google Scholar 

  10. Cheigh, J. S. et al. Systemic lupus erythematosus in patients with end-stage renal disease: long-term follow-up on the prognosis of patients and the evolution of lupus activity. Am. J. Kidney Dis. 16, 189–195 (1990).

    CAS  Article  Google Scholar 

  11. Okano, K. et al. Analysis of lupus activity in end-stage renal disease treated by hemodialysis. Intern. Med. 40, 598–602 (2001).

    CAS  Article  Google Scholar 

  12. Szeto, C. C., Li, P. K., Wong, T. Y., Leung, C. B. & Lui, S. F. Factors associated with active systemic lupus erythematosus after end-stage renal disease. J. Rheumatol. 25, 1520–1525 (1998).

    CAS  PubMed  Google Scholar 

  13. Pellicano, R. et al. Autoimmune manifestations during interferon therapy in patients with chronic hepatitis C: the hepatologist's view. Minerva Gastroenterol. Dietol. 51, 55–61 (2005).

    CAS  PubMed  Google Scholar 

  14. RxList: The Internet Drug Index. Pegasys [online], (2009).

  15. Selmi, C. et al. Interferon α and its contribution to autoimmunity. Curr. Opin. Investig. Drugs 7, 451–456 (2006).

    CAS  PubMed  Google Scholar 

  16. Santiago-Raber, M. L. et al. Type-I interferon receptor deficiency reduces lupus-like disease in NZB mice. J. Exp. Med. 197, 777–788 (2003).

    CAS  Article  Google Scholar 

  17. Akhan, S. C., Kalender, B. & Ruzgar, M. The response to pegylated interferon α2a in haemodialysis patients with hepatitis C virus infection. Infection 36, 341–344 (2008).

    CAS  Article  Google Scholar 

  18. Zimmermann, T. et al. Efficacy of an escalating dose regimen of pegylated interferon α2a plus ribavirin in the early phase of HCV reinfection after liver transplantation. Transpl. Int. 20, 583–590 (2007).

    CAS  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sanjay Kumar Agarwal.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Agarwal, S., Lal, C. & Zaidi, S. Lupus activation with cerebritis following pegylated interferon in a hemodialysis patient. Nat Rev Nephrol 5, 599–603 (2009). https://doi.org/10.1038/nrneph.2009.137

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrneph.2009.137

Further reading

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing