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Published Online, 13 September 2005, www.theannals.com, DOI 10.1345/aph.1G144.
 The Annals of Pharmacotherapy: Vol. 39, No. 10, pp. 1745-1747. DOI 10.1345/aph.1G144
© 2005 Harvey Whitney Books Company.
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Hashimoto Encephalopathy with Pegylated Interferon Alfa-2b and Ribavirin

Melanie Deutsch, MD1, John Koskinas, MD2, Konstatinos Tzannos, MD3, Dimitrios Vassilopoulos, MD4, Antonis Mailis, MD5, George Tolis, MD6, and Stephanos Hadziyannis, MD7

1 Senior Registrar, Academic Department of Internal Medicine, Hippocration General Hospital Athens, Athens, Greece
2 Assistant Professor of Internal Medicine, Academic Department of Internal Medicine, Hippocration General Hospital Athens
3 Registrar, Academic Department of Internal Medicine, Hippocration General Hospital Athens
4 Assistant Professor of Internal Medicine, Academic Department of Internal Medicine, Hippocration General Hospital Athens
5 Professor of Neurology, Academic Department of Medicine, Hippocration General Hospital Athens
6 Professor of Endocrinology, Academic Department of Internal Medicine, Hippocration General Hospital Athens
7 Hepatology Department, Henry Dunant Hospital, Athens

Reprints: Dr. Deutsch, Academic Department of Internal Medicine, Hippocration General Hospital Athens, Vas. Sofias 114, 11527 Athens, Greece, fax 03 210 7706871, kostam{at}ath.forthnet.gr

OBJECTIVE: To report an instance of Hashimoto encephalopathy probably resulting from pegylated interferon alfa-2b and ribavirin.

CASE SUMMARY: A 36-year-old woman with a 10-year history of autoimmune thyroiditis presented with symptoms and signs consistent with Hashimoto encephalopathy during therapy with pegylated interferon alfa-2b and ribavirin for chronic hepatitis C.

DISCUSSION: Hashimoto encephalopathy is a rare autoimmune condition that occurs in patients with Hashimoto thyroiditis and high titers of antithyroid antibodies. It is characterized by a variety of nonspecific neuropsychiatric symptoms, increased cerebrospinal fluid protein level, and abnormal brain imaging and electroencephalogram. Prompt response to corticosteroids is observed in most cases. As of August 29, 2005, this is the first report of such an association. An objective causality assessment revealed that the Hashimoto encephalopathy was probably caused by the patient's medications.

CONCLUSIONS: Hashimoto encephalopathy may rarely be triggered by interferon alfa therapy in susceptible patients.

Key Words: chronic hepatitis C, Hashimoto encephalopathy, pegylated interferon alfa-2b

Published Online, September 13, 2005. www.theannals.com, DOI 10.1345/aph.1G144




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