Pantoea agglomerans sepsis in a patient with chronic hepatitis C during peginterferon (PEG-IFN) plus ribavirin (RBV) therapy

Background: Treatment with PEG-IFN is known to increase the risk of bacterial infections; nevertheless, severe sepsis is relatively uncommon. We report here a case of severe septic pyelonephritis complicating PEG-IFN plus RBV therapy in a pt with chronic hepatitis C.

Case report: From April 2005, a 46-year-old woman with chronic hepatitis C (with a histological activity index of 6 and Scheuer's stage 2) was treated with PEG-IFN-alpha-2a in combination with RBV. By week 12, her treatment had yielded a good early virological response, and in the first 5 months there were no significant adverse events. At week 20, the regular laboratory check-up showed a fairly good blood neutrophil count of 1.3 G/L. Two weeks later, she experienced fever of 38 to 39°C, with fatigue and anorexia, and her family doctor therefore prescribed oral cefuroxime. Her fever subsequently transiently diminished. At the regular check-up at week 24, she was unwell and had high fever again, and she was therefore admitted to our hospital unit. The clinical investigations led to a diagnosis of acute pyelonephritis on the right side, with sideropenic anemia; the neutrophil count was normal (2.3 G/L). The serum procalcitonin level was elevated, and blood cultures yielded Pantoea agglomerans, susceptible to all antibiotics tested. The administration of PEG-IFN plus RBV was stopped, and treatment with intravenous ceftriaxone resulted in a cure.

Conclusion: This observation confirms that severe bacterial infection can develop during PEG-IFN plus RBV therapy, even in the absence of marked neutropenia. Accordingly, early signs of a bacterial infection during treatment must be followed by careful clinical investigations, since early diagnosis and adequate treatment of intercurrent infections are required to avoid septic complications.