A 54-year-old Caucasian woman with chronic HCV
infection started treatment with
ribavirin and
peginterferon alfa-2a. Four months later, oral
propranolol hydrochloride 20 mg three times daily was initiated due to an episode of
paroxysmal supraventricular tachycardia (PSVT). One month later, the patient developed a diffuse pruritic
rash.
Hydroxyzine and
loratadine were prescribed for several days to treat the
rash. Three weeks later, she arrived at the emergency department with generalized
edema and a severe pruritic erythematous swelling that affected the face, forearms, hands, and lower extremities. The patient was diagnosed with
angioedema. Blood tests revealed an increased eosinophil count (910 cells/microL), elevated
aspartate transaminase and
alanine transaminase concentrations (109 and 104 IU/L, respectively), and a high HCV
RNA load (1,450,000 IU).
Peginterferon alfa-2a,
ribavirin, and
propranolol were discontinued. A few days later, the
edema and cutaneous lesions disappeared. Six months after the resolution of the
angioedema, the patient was seen again in the emergency department because of another episode of PSVT. Oral
propranolol 20 mg twice daily was reintroduced to control the
tachycardia. Two days later, a similar episode of diffuse edematous swelling developed. At that time, the only
drug she was taking was
propranolol.
Propranolol was discontinued, and the patient's symptoms spontaneously resolved.
CONCLUSION: