<Case Reports>Prolonged psychiatric symptoms induced by recombinant alpha-2a interferon in a patient with chronic hepatitis C

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While receiving recombinant alpha-2a interferon (INF) therapy (total dose, 78×10^6 IU) for chronic active hepatitis C, a 56-year-old male exhibited neuropsychiatric manifestations of mild encephalopathy consisting of disorientation regarding time, impaired recent memory and word-finding ability, incoherent thought processes, anxiety, and agitation associated with suicidal ideas. The INF therapy was discontinued after two weeks because of these symptoms. Electroencephalogram (EEG) recorded during the mild encephalopathic state demonstrated diffuse θ to slow α-waves in the background without paroxysmal patterns. Magnetic resonance imaging of the brain revealed some small areas of high signal intensity in the white matter which were suggestive of lacunae. Although the neuropsychiatric symptoms subsided two weeks following the cessation of INF, prolonged mental symptoms including lack of volition, interest and labour efficiency persisted for more than 15 months thereafter. The EEG demonstrated slow α-waves in the background mixed with sporadic θ-waves. We speculate that the neuropsychiatric manifestations of encephalopathy may have been induced by INF which crossed the blood-cerebrospinal fluid barriers. Furthermore, we infer that the INF induced and enhanced a latent organic mental syndrome involved in the asymptomatic multiple lacunary infarctions observed in this patient.
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