Reactivation of hepatitis C virus caused by steroid monotherapy for sudden deafness

Abstract

Hepatitis C virus (HCV) reactivation has been reported to be caused due to several anticancer drugs and immunosuppressive agents; however, HCV reactivation after steroid monotherapy has rarely been reported. Here, we report the case of a 65-year-old Japanese man with HCV infection who developed HCV reactivation after the administration of prednisolone (PSL) for 6 days for sudden deafness. In the patient history, the positivity for anti-HCV antibody was observed, but serum level of HCV RNA was not measured. Two months after PSL administration, the patient experienced an alanine aminotransferase (ALT) flare and the serum level of HCV RNA was observed to be 6.2 log IU/mL; then, the patient was admitted to our hospital for hepatitis treatment. Based on the clinical course and laboratory findings, the patient was diagnosed with HCV reactivation. Although the ALT levels decreased spontaneously during follow-up, they did not drop to normal range; subsequently, sofosbuvir and ledipasvir treatments were started. A sustained virological response 24 weeks after the end of treatment was achieved. This case study suggests that HCV reactivation with hepatitis flare can occur even after a steroid monotherapy, and doctors should pay attention to HCV reactivation when administering PSL for patients with HCV infection.

Keywords: HCV reactivation; Steroid; Sudden deafness.

Fig. 1

Representative images of abdominal ultrasonography and computed tomography (CT) in the present case. Images of ultrasonography (a) and CT (b) showing that the liver was not cirrhotic, but the liver edge was slightly dull

Fig. 2

The clinical course of the patient. HCV RNA hepatitis C virus RNA, ALT alanine aminotransferase, PSL prednisolone, SOF/LDV sofosbuvir/ledipasvir