Lupus syndrome, hypothyroidism and bullous skin lesions after interferon alfa therapy for hepatitis C in a haemodialysis patient

Case. A 37-year-old woman undergoing haemodialysis (HD) in August 1983 following focal segmental glomerulosclerosis received a kidney donated by her father in July 1985. In 1994, hepatitis C (HCV), genotype 1a, was discovered during a routine follow-up. In August 1997, liver biopsy demonstrated a stage 2, grade 2 hepatitis by the Metavir score. In September 1998, HD was recommenced due to chronic rejection. In October 1998, HCV-RNA was positive with 500 000 copiesuml. ANA with indirect IF were negative and thyroid tests were normal. Recombinant IFN-a 2a therapy (Roferon Roche) 3 MU three times weekly following dialysis was commenced. During the first 2 months of treatment, the patient presented with flu-like symptoms treated with paracetamol. Following 3 months of treatment, the viral blood count was negative. In September 1999, the patient presented with tiredness, arthralgia, myalgia, pruritic bullous skin lesions and suicidal thoughts. Blood results demonstrated the following: ANA 1u2560 (normal 1u40), anti DNA-antibodies (AB) in Elisa 100 U (normal -30 U), antinucleosomic AB in Elisa 33 U (normal-10 U), complement in RIA 4.1 Uuml (normal )23 Uuml), free T3 in RIA 1.45 pguml (normal 1.8–4.6 pguml), free T4 in RIA 0.16 ngul (normal 0.97–1.72 ngul), TSH in RIA 236 mUuml (normal 0.27–4 mUuml), anti-TPO AB 605 IUuml (normal 100 IUuml), anti-thyroglobulin AB 740 IUuml (normal -300 IUuml) and anti-intercellular-substance AB with indirect IF. IFN-a was discontinued. The malaise and pain disappeared after 1 month and the skin lesions and depression after 3 months. In January 2000, blood tests were negative except for ANA 1u1280 and anti-DNA AB 80 U. In February 2001, lupic markers had disappeared. HCV-RNA remained negative.