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Colitis Following Initiation of Sofosbuvir and Simeprevir for Genotype 1 Hepatitis C.

Sarkar S, Mitchell KA, Lim JK, Oikonomou I, Jakab S - ACG Case Rep J (2015)

Bottom Line: Both drugs have been well-tolerated, with diarrhea noted in 6% cases with sofosbuvir, 16% with sofosbuvir plus simeprevir, and 0% with simeprevir.No prior reports exist of colitis secondary to either drug or their combination.Colonoscopy and biopsy confirmed pancolitis, which responded to mesalamine and completion of sofosbuvir/simeprevir.

View Article: PubMed Central - PubMed

Affiliation: Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT.

ABSTRACT
Sofosbuvir and simeprevir are used for the treatment of chronic hepatitis C (HCV) genotype 1. Both drugs have been well-tolerated, with diarrhea noted in 6% cases with sofosbuvir, 16% with sofosbuvir plus simeprevir, and 0% with simeprevir. No prior reports exist of colitis secondary to either drug or their combination. We report a patient with no prior history of inflammatory bowel disease who developed significant bloody diarrhea within 2 weeks of sofosbuvir/simeprevir initiation. Colonoscopy and biopsy confirmed pancolitis, which responded to mesalamine and completion of sofosbuvir/simeprevir.

No MeSH data available.


Related in: MedlinePlus

Endoscopic and microscopic images of the colon indicative of chronic active colitis at week 4 of sofosbuvir/simeprevir therapy. (A, B) Erythematous friable mucosa with exudates without skip areas. (C) Marked increase in lamina propria lymphoplasmacytic inflammatory infiltrate, significant basal lymphoplasmacytosis with reactive lymphoid aggregates, mucosal distortion, lamina propria neutrophils, acute cryptitis, crypt abscesses, and surface damage suggestive of erosions.
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Figure 1: Endoscopic and microscopic images of the colon indicative of chronic active colitis at week 4 of sofosbuvir/simeprevir therapy. (A, B) Erythematous friable mucosa with exudates without skip areas. (C) Marked increase in lamina propria lymphoplasmacytic inflammatory infiltrate, significant basal lymphoplasmacytosis with reactive lymphoid aggregates, mucosal distortion, lamina propria neutrophils, acute cryptitis, crypt abscesses, and surface damage suggestive of erosions.

Mentions: A 50-year-old Hispanic man with HCV genotype 1 and well-compensated cirrhosis was evaluated for retreatment of HCV. He was a responder/relapser to telaprevir, pegylated interferon, and ribavirin, but otherwise had an unremarkable medical history. He was a non-smoker with remote history of alcohol use, unremarkable family history, no known allergies, and was not taking any prescribed medications or supplements. He was interferon-ineligible due to thrombocytopenia, and started treatment with sofosbuvir 400 mg and simeprevir 150 mg daily. After 2 weeks of treatment, he noted increased flatulence and loose stool with intermittent blood. This was presumed to be self-limited, and a possible side effect of sofosbuvir/simeprevir, but worsened over the following 2 weeks. Stool studies for Clostridium difficile, bacterial culture, and ova and parasites were negative. Serum albumin was 4 g/dL, and electrolytes, blood panel, and coagulation laboratory tests were normal, except for low platelets at baseline. He underwent sigmoidoscopy, which revealed erythematous friable mucosa without skip areas, with chronic active colitis on biopsy (Figure 1).


Colitis Following Initiation of Sofosbuvir and Simeprevir for Genotype 1 Hepatitis C.

Sarkar S, Mitchell KA, Lim JK, Oikonomou I, Jakab S - ACG Case Rep J (2015)

Endoscopic and microscopic images of the colon indicative of chronic active colitis at week 4 of sofosbuvir/simeprevir therapy. (A, B) Erythematous friable mucosa with exudates without skip areas. (C) Marked increase in lamina propria lymphoplasmacytic inflammatory infiltrate, significant basal lymphoplasmacytosis with reactive lymphoid aggregates, mucosal distortion, lamina propria neutrophils, acute cryptitis, crypt abscesses, and surface damage suggestive of erosions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4612757&req=5

Figure 1: Endoscopic and microscopic images of the colon indicative of chronic active colitis at week 4 of sofosbuvir/simeprevir therapy. (A, B) Erythematous friable mucosa with exudates without skip areas. (C) Marked increase in lamina propria lymphoplasmacytic inflammatory infiltrate, significant basal lymphoplasmacytosis with reactive lymphoid aggregates, mucosal distortion, lamina propria neutrophils, acute cryptitis, crypt abscesses, and surface damage suggestive of erosions.
Mentions: A 50-year-old Hispanic man with HCV genotype 1 and well-compensated cirrhosis was evaluated for retreatment of HCV. He was a responder/relapser to telaprevir, pegylated interferon, and ribavirin, but otherwise had an unremarkable medical history. He was a non-smoker with remote history of alcohol use, unremarkable family history, no known allergies, and was not taking any prescribed medications or supplements. He was interferon-ineligible due to thrombocytopenia, and started treatment with sofosbuvir 400 mg and simeprevir 150 mg daily. After 2 weeks of treatment, he noted increased flatulence and loose stool with intermittent blood. This was presumed to be self-limited, and a possible side effect of sofosbuvir/simeprevir, but worsened over the following 2 weeks. Stool studies for Clostridium difficile, bacterial culture, and ova and parasites were negative. Serum albumin was 4 g/dL, and electrolytes, blood panel, and coagulation laboratory tests were normal, except for low platelets at baseline. He underwent sigmoidoscopy, which revealed erythematous friable mucosa without skip areas, with chronic active colitis on biopsy (Figure 1).

Bottom Line: Both drugs have been well-tolerated, with diarrhea noted in 6% cases with sofosbuvir, 16% with sofosbuvir plus simeprevir, and 0% with simeprevir.No prior reports exist of colitis secondary to either drug or their combination.Colonoscopy and biopsy confirmed pancolitis, which responded to mesalamine and completion of sofosbuvir/simeprevir.

View Article: PubMed Central - PubMed

Affiliation: Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT.

ABSTRACT
Sofosbuvir and simeprevir are used for the treatment of chronic hepatitis C (HCV) genotype 1. Both drugs have been well-tolerated, with diarrhea noted in 6% cases with sofosbuvir, 16% with sofosbuvir plus simeprevir, and 0% with simeprevir. No prior reports exist of colitis secondary to either drug or their combination. We report a patient with no prior history of inflammatory bowel disease who developed significant bloody diarrhea within 2 weeks of sofosbuvir/simeprevir initiation. Colonoscopy and biopsy confirmed pancolitis, which responded to mesalamine and completion of sofosbuvir/simeprevir.

No MeSH data available.


Related in: MedlinePlus