Interferon-alpha-2b/ribavirin-induced vestibulocochlear toxicity with dysautonomia in a chronic hepatitis C patient

[Guest guest]

Eur J Gastroenterol Hepatol. 2008 Nov;20(11):1110-4.

Interferon-alpha-2b/ribavirin-induced vestibulocochlear toxicity with

dysautonomia in a chronic hepatitis C patient.

K, Sargent LA, Galizio C, Ubogu EE.

aNeurology bAudiology Services, Louis Stokes Cleveland Department of Veterans

Affairs Medical Center, Case Western Reserve University School of Medicine,

Cleveland, Ohio, USA.

A 57-year-old man developed vertigo, tinnitus, bilateral hearing loss and

postural intolerance temporally related to the administration of pegylated

interferon-alpha-2b/ribavirin for chronic hepatitis C viral infection. Clinical

examination showed bilateral sensorineural hearing loss, subjective vertigo with

saccadic intrusions during fixation and smooth visual pursuit, and supine

hypertension followed by orthostatic hypotension with inadequate reflexive

compensatory cardiovascular responses. Laboratory assessment showed marked

hemolytic anemia. Formal audiometry revealed high-frequency sensorineural

hearing loss with abnormal high-frequency distortion product otoacoustic

emissions, indicative of damage to the cochlear outer hair cells. Cessation of

therapy resulted in rapid clinical resolution with mild residual hearing loss

and tinnitus. This case report illustrates vestibulocochlear and autonomic

nervous system adverse effects of pegylated interferon-alpha-2b/ribavirin,

emphasizing the importance of early recognition and cessation of therapy to

prevent permanent neurootologic injury.

PMID: 19047844 [PubMed - in process]