Session Information
Date: Wednesday, June 7, 2017
Session Title: Choreas (Non-Huntington’s Disease)
Session Time: 1:15pm-2:45pm
Location: Exhibit Hall C
Objective: We reported a case of a patient G., 47 years old treated with Pegintron (1,5 mcg/kg/week) and ribavirin (15 mg/kg/day) within a year due to hepatitis C.
Background: G. has a history of heroine abuse (withdrawn from 2011) and HIV infection from 2006.
Methods: Immediately after injection of Pegintron G. experienced symptoms as after “heroine withdrawal”. In a month from the start G. noticed problems with eye movements, then painful involuntary movements in left leg joined up. In a few months the patient experienced severe painful involuntary twisting rotation to the left side of the body, choreic movements in the limbs partially provoked by the movements and half-relieved by correcting gestures (glasses and touch of the ear). G. passed whole course of treatment (54 weeks). After treatment the symptoms lingered with no evident progression. G. tried to use benzodiazepines, haloperidol and aminazin, levodopa for alleviation of symptoms with no positive effect. G. completed a course of prednisolone treatment (60 mg/day for a week) and continues administering it (80 mg/day for a month). There is no obvious improving by the day.
The patient is observed in AIDS-center in Kazan and never received antiretroviral treatment. The treatment of hepatitis C was successful.
Results: According to FDA reports Pegintron causes chorea in 0.031% of cases. There are several possible mechanisms of choreodystonia development in a patient with history of heroine abuse and HIV infection. It is considered interferons can aggravate suppressive action on nigrostriatal pathway and have different types of direct and indirect influences (secondary neurotoxic effects). Furthermore, induction or exacerbation of preexisting autoimmune disease is a relatively frequent occurrence in patients treated with type alpha-interferons. Thus we cannot totally exclude autoimmune ethiology of chorea. Sensitization of opioid receptors occurred after withdrawal can prominently contribute the pathophysiology of this side effect. Interestingly that during concomitant metadone usage there were no observed extrapyramidal side effects.
Conclusions: So here we reported first case of generalized choreadystonia caused by combo-treatment by pegylated interferon alpha (Pegintron) and ribavirin in a patient with hepatitis C and concomitatnt history of heroin abuse and HIV infection.
References: Safety, Tolerability, and Immunogenicity of Interferonsю Michael G. Tovey, Christophe Lallemand. Pharmaceuticals 2010, 3, 1162-1186; doi:10.3390/ph3041162.
http://factmed.com/study-PEG-INTRON-causing-CHOREA.php
To cite this abstract in AMA style:
D. Khasanova, Z. Zalyalova. Generalized choreodystonia in a patient with HIV and hepatitis C with the history of opioid drug abuse after treating with interferon- 2alpha (Peginton) [abstract]. Mov Disord. 2017; 32 (suppl 2). https://www.mdsabstracts.org/abstract/generalized-choreodystonia-in-a-patient-with-hiv-and-hepatitis-c-with-the-history-of-opioid-drug-abuse-after-treating-with-interferon-2alpha-peginton/. Accessed May 16, 2025.« Back to 2017 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/generalized-choreodystonia-in-a-patient-with-hiv-and-hepatitis-c-with-the-history-of-opioid-drug-abuse-after-treating-with-interferon-2alpha-peginton/