1 Platelet and HCV viral weight. an unsuccessful standard therapy with two programs of intravenous immunoglobulin (at 1?g/kg daily for 2?days) associated with methylprednisolone 1?mg/kg daily, antiviral treatment with sofosbuvir-ledipasvir rapidly achieved virological response and normalised the platelet count. Conclusions As a direct effect of HCV on megakaryocytes could be the predominant cause of ITP during acute infection, early antiviral treatment may be beneficial in this case. Electronic supplementary material The online version of this article (10.1186/s12879-018-3597-4) contains supplementary material, which is available to authorized users. Gamma Glutamine Transferase, em PT Prothrombine time, aPTT Activated Partial Thromboplastin Time /em Open in a separate window Fig. 1 Platelet and HCV viral weight. Acute genotype 1a HCV reinfection was diagnosed on August 2017 on a systematic survey, with 11 xULN ALT and 5.91 log IU/mL RU 24969 hemisuccinate HCV RNA. Platelets were found at 5?G/L for the unit admission on August 30, 2017. First course of IVIG was administrated on August 31, at the dose of 1 1?g/kg about day time 1 and day time 3, with clinical benefit but no effect on the platelet count. Second IVIG program was administrated on September 05 in association with methylprednisolone 1?mg/kg daily. Sofosbuvir-ledipasvir was started on September 11, allowing a sustained recovery of the platelet count with a quick viral weight RU 24969 hemisuccinate control (basal blue collection represents an undetectable HCV viral weight, inferior to 12?IU/mL). IVIG: intravenous immunoglobulin, MP: methylprednisolone, SOF-LDV: sofusbuvir-ledispavir, ALT: Alanine transaminase, HCV: Hepatitis C disease An initial administration of intravenous immunoglobulin (IVIG; in the dose of 1 1?g/kg about day time 1 and day time 3) had clinical benefit (regression of gum bleeding and purpura), but did not have any effect on the platelet count which remained below 10G/L. A second administration of IVIG (1?g/kg daily for 2?days) combined with methylprednisolone (1?mg/kg daily) improved platelet count which reached 40G/L but a normal value was not attained (Fig.?1). At which point it was determined after collegial conversation Rabbit Polyclonal to RAD50 to start treating the infectious result in. Pegylated IFN and ribavirin combination was contra-indicated because of severe thrombocytopenia, therefore a 12?weeks course of sofosbuvir-ledipasvir was indicated. At initiation of the treatment, the platelet count was 43?G/L and HCV viral weight was 6.3 log IU/mL. At day time 15 of antiviral treatment, HCV viral weight was undetectable ( ?12?IU/ml) and the platelet count had increased to 108?G/L allowing rapid tapering and discontinuation of corticosteroids before the end of antiviral therapy. HCV viral weight remained undetectable until week 12 post-treatment, confirming HCV treatment (Fig.?1). Platelet count fully normalised 5? weeks following treatment initiation and remained within RU 24969 hemisuccinate normal range thereafter. The patient went through his 12?weeks course of sofosbuvir-ledipasvir with a good tolerance, without any specific adverse event reported. Conversation and conclusions Chronic HCV illness has been associated with immune thrombocytopenia; the incidence is definitely estimated to be 30.2C53 instances / 100,000 person-years [5, 6]. Conversely, HCV antibodies have been found in RU 24969 hemisuccinate 10 to 36% of individuals with chronic ITP in cross-sectional studies [5, 6]. However, our case is definitely a rare statement of ITP in the context of acute hepatitis C. Only one related case has already been reported by Narita et al. in 2003 [7]. Relating to this statement, ITP also occurred at the second HCV illness after a first HCV infection cured by 6?weeks of IFN-2b. HCV genotype was found to be 2a with this reinfection case, versus 2b for the 1st one. In contrary to our findings, platelet connected immunoglobulins (PAIgG) were found positive with this report, with no additional circulating antibodies (antinuclear antibody and rheumatoid element were bad). Additionally, platelet count RU 24969 hemisuccinate improved up to 39,000 /L spontaneously and the PAIgG returned to the normal ratio without any.
1 Platelet and HCV viral weight
