Mild to moderate
autoimmune thrombocytopenia (AITP) is a common finding in patients receiving
interferon-based
antiviral treatment, due to bone marrow suppression. Here we report the case of a patient with chronic genotype 1b hepatitis C virus (HCV)
infection treated with pegylated-
interferon alpha-2a,
ribavirin and
telaprevir for 24 wk; the patient developed severe AITP three weeks
after treatment withdrawal. We performed a systematic literature search in order to review all published cases of AITP related to HCV
antiviral treatment. To our knowledge, this is the second case of AITP observed after
antiviral treatment withdrawal. In most published cases AITP occurred during treatment; in fact, among 24 cases of AITP related to
interferon-based
antiviral treatment, only one occurred after discontinuation. Early diagnosis of AITP is a key factor in order to achieve an early
interferon discontinuation; in the era of new direct
antiviral agents those patients have to be considered for
interferon-free treatment regimens. Prompt prescription of immuno-suppressant treatment (i.e.,
corticosteroids,
immunoglobulin infusion and even
rituximab for unresponsive cases) leads to favourable prognosis in most of cases. Physicians using
interferon-based treatments should be aware that AITP can occur both during and
after treatment, specially in the new era of
interferon-free
antiviral treatment. Finally, in the case of suspected AITP, presence of anti-platelet
antibodies should be checked not only during treatment but also after discontinuation.