1 / 11

Antiphospholipid antibody syndrome due to interferon  treatment for hepatitis C

Antiphospholipid antibody syndrome due to interferon  treatment for hepatitis C. Michi Shinohara, MD Pacific Dermatologic Association August 10, 2008. Case presentation. 53 yo woman with 3 week history of progressive superficial cutaneous thrombosis

romeo
Télécharger la présentation

Antiphospholipid antibody syndrome due to interferon  treatment for hepatitis C

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Antiphospholipid antibody syndrome due to interferon treatment for hepatitis C Michi Shinohara, MD Pacific Dermatologic Association August 10, 2008

  2. Case presentation • 53 yo woman with 3 week history of progressive superficial cutaneous thrombosis • History of Hep C with cryoglobulinemia and cutaneous vasculitis, s/p IFN and ribavarin • IVDU > 10y ago, current skin lesions in areas of prior injection • Health otherwise stable, no dyspnea, chest pain or leg edema

  3. Work up • Upper extremity duplex confirmed superficial clot; no DVT • Assessed for hypercoaguable state • Anticardiolipin antibodies, lupus anticoagulant, inherited thrombophilias, cryoglobulins negative • 2 glycoprotein-1 Ab (2-GP-1) titer >99th percentile • Referred to hematology, initiated on anticoagulation for antiphospholipid antibody syndrome (APS)

  4. Antiphospholipid antibody syndrome • Primary or secondary (SLE) • Diagnosis based on antiphospholipid antibodies “aPL Abs” (LA, aCL, 2-GP-1) and clinical features (thrombosis, fetal loss) • Pathogenesis due to aPL Ab binding to phospholipid associated proteins, especially 2-GP-1 • Main antigenic target of aPL Abs • Clotting inhibitor required for binding of aCL with cardiolipin

  5. Autoantibodies and hepatitis C • Development of autoantibodies in setting of hepatitis C is common - RF • APL Abs including aCL1, LA2 reported in up to 46% of those with hepatitis C • APS in hepatitis C rare, incidence not increased in setting of hepatitis C1,2 • aPL Abs due to infection “cofactor independent”, nonthrombogenic • No increased incidence of 2-GP-1 antibodies Ordi-Ros et al, (2000) Clin and Diag Lab Immuno 7:241-244 Amin, N (2008) Hematol Oncol Clin N Am 22:131-143

  6. Antiphospholipid antibody syndrome and interferon • Autoantibodies and immune phenomenon common during IFN therapy • Thyroid antibodies in 22% • Appearance or exacerbation of SLE, sarcoidosis1 • Our patient had mildly elevated 2-GP-1 antibodies prior to therapy (22 SGU, ref range 0-9) which rose markedly after IFN • Also developed sarcoidosis in tattoo 1. Hauschild et al (2008) J Deutschem Dermatol ISSN: 1610-0387 (Online)

  7. Conclusions • Numerous autoimmune phenomena attributable to hepatitis C as well as immunomodulatory treatment • Although development of APS is rare, consider screening for aPL Abs in patients with thrombosis in setting of hepatitis C or interferon treatment

  8. Thank you Dr John Olerud, Division head; Claudia Davis ARNP, and the Pacific Derm Association

More Related