We report an autopsied case of a 59-year-old woman with acute
septic shock from methicillin-resistant Staphylococcus aureus (MRSA)
infection during combination
therapy with pegylated-interferon-α-2b (PEG-IFNα-2b) and
ribavirin. She underwent aortic graft replacement for the treatment of a
dissecting aneurysm. We observed her
latent infection closely for over a year following the operation. The clinical and laboratory examinations did not show any sign of
infection. She then underwent PEG-IFNα-2b/
ribavirin combination
therapy. In her 17th week of
therapy, she suddenly complained of high
fever followed by a markedly rapid progression of
sepsis and
disseminated intravascular coagulation. She died of acute
septic shock from MRSA
infection on her fourth hospital day. Autopsy revealed
abscess formation in the mediastinum around the artificial vessel graft. There was no obvious
verruca on the internal surface of the replaced graft. Microscopic examination revealed numerous cocci along the thread in the
suture of the graft. This clinical experience shows that combination
therapy with PEG-IFNα-2b/
ribavirin for the treatment of
chronic hepatitis C should be given careful consideration when administered to patients who have undergone major vessel surgery, such as aortic graft replacement. Once the treatment has been started,
infection should be monitored with particular care and frequent medical examinations.