CASE REPORT Pegylated interferon alpha-2a-associated life-threatening Evans’ syndrome in a patient with chronic hepatitis C Olivier Lambotte a, * , Moana Gelu-Simeon b , Gwenola Maigne a , Rami Kotb a , Catherine Buffet b , Jean Franc ¸ois Delfraissy a , Ce ´cile Goujard a a Department of Internal Medicine, Kremlin Bice ˆtre Hospital, AP-HP, 78 rue du Ge ´ne ´ral Leclerc, 94275 Le Kremlin Bice ˆtre, France b Department of Gastroenterology, Kremlin Bice ˆtre Hospital, AP-HP, 78 rue du Ge ´ne ´ral Leclerc, 94275 Le Kremlin Bice ˆtre, France Accepted 18 October 2004 KEYWORDS Hepatitis C; Interferon; Side-effect; Haemolytic anaemia; Thrombocytopenia Abstract In this report, we describe an unusual and unreported complication with the new licensed form of pegylated interferon a2a (PEG-IFN-a2a). We report the first case of severe autoimmune cytopenias, an Evans’ syndrome, in a patient with chronic hepatitis C, 2 months after PEG-IFN-a2a initiation. Haemolytic anaemia and thrombocytopenia developed, complicated by gastric bleeding and brain haemor- rhage. Outcome was favourable under immunosuppressive treatment. Treatment with PEG-IFN-a2a requires careful follow-up, as IFNa can induce or exacerbate autoimmune diseases. Q 2005 The British Infection Society. Published by Elsevier Ltd. All rights reserved. Thrombocytopenia is a common finding in liver cirrhosis, usually related to splenomegaly of portal hypertension and possible inadequate thrombo- poietin synthesis by the liver. 1 In patients treated with interferon-a (IFN), mild thrombocytopenia and neutropenia are frequent but generally not associ- ated with clinically significant complications. These cytopenias have been attributed to a direct inhibition of hematopoiesis by IFN. IFN-a may also exacerbate or induce autoimmunity. Rare cases of immune thrombocytopenia have been reported with non-pegylated-IFN-a and two cases have been described with PEG-IFN-a2b. 2,3 We report here the first case of a life-threatening Evans’ syndrome, during PEG-IFN-a2a treatment for chronic hepatitis C. Case report A 73-year-old woman presented with chronic hepatitis C. The viral genotype was 1b, hepatitis C virus (HCV) plasma viral load was 174 000 copies/ml Journal of Infection (2005) 51, e113–e115 www.elsevierhealth.com/journals/jinf 0163-4453/$30.00 Q 2005 The British Infection Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jinf.2004.10.010 * Corresponding author. Tel.: C33 1 45 21 25 33; fax: C33 1 45 21 26 32. E-mail address: olivier.lambotte@bct.ap-hop-paris.fr (O. Lambotte).