1. Chronic HCV Patient Developed Severe Neutropenia and Sepsis on Peg/Riba

2. History
56 y/o male from Cuba newly diagnosed with hepatitis C genotype 2b in Jan 2008
No symptoms of decompensation

3. PMx PSx Meds Social Hx Diabetes HTN None None regular
Drinking – quit 2007
Blood t/f 17 yo
Entertainer

4. Baseline Labs WBC 4.8 HgB 17.1 Plt 160 TB 0.9 AST 293 ALT 386
Cr MELD 7

5. Work up reveals Egd – no varices Labs – genotype 2b
Negative for other CLD
AFP 68
Imaging reveals cirrhosis
Mass lesion in liver suspicious for HCC

6. MRI Jan 2008

7. MRI Jan 2008 Cirrhotic liver
Multiple subcentimeter areas of intense enhancement during arterial phase at the peripheral right lobe

8. Referred to Liver Tx Referred to Transplant Surgeon
Reviewed CT and MRI
2 lesions in liver both < 2 cm
Not completely characteristic for HCC
Plan for lap biopsy +/- RFA or resection
Pt decided to follow lesions on imaging

9. Clinical Course Started Rx Pegylated interferon 120 mcg/week
Ribavirin 1000 mg /day

10. Clinical Course Week 0 Week 4 Week 8 Week 10 Viral load 2.79 million
Patient
AST 75 20 24
went
ALT 78 16 12 to
Spain
WBC
4800
3600
1700
1000
Neu
2400
1900
500
AFP 69

11. Spain Developed fever WBC 0.5 Neu 20 Admitted to hospital
Intubated for Staph pneumonia and sepsis
Discharged after 3 weeks

12. Clinical Course Week 0 Week 4 Week 8 Week 11 Viral load 2.79 million
AST 75 20 24 18
ALT 78 16 12 14
WCC
4800
3600
1700
500
Neu
2400
1900
1000
AFP 69
Rx stopped

13. Jan 2008
Dec 2008

14. Post Treatment Follow up
Week 12
Week 24
Viral Load
AST 17 19
ALT 16 15
WCC
4100
4500
Neu
2200
2500
AFP
6.1
5.6

15. Post Treatment Follow Up
Week 12
Week 24
Week 34
Viral load
206,000
AST 17 19
426
ALT 16 15
635
WCC
4100
4500
4800
Neu
2200
2500
2700
AFP
6.1
5.6

16. Follow Up Genotype came back genotype 2b
Patient later retreated and achieved SVR