Male, 57 years old, history of no interest and smoker of 10-20 cigarettes/day. The patient presented with chronic hepatitis C genotype 1a/1c, viral load 1,662,178 Ul/ml and a fibrosis grade F2-F3 (Fibroscan 9.9 Kilopascals) with an IL-28 CT polymorphism. It was decided to start his first treatment for hepatitis C with RBV 400mg/12h, P-INF alpha 2a 180mcg/week and Telaprevir 750mg/8h (with meals). At the start of treatment the patient had a haemoglobin (Hb) of 157 g/L, neutrophil count 4.2x109 no/L and 1 58x109 no/L platelets. Liver enzymes were slightly increased, GPT 114 IU/L, ALAT 115 IU/L and ASAT 80 IU/L.
At week 4 the patient presented undetectable viral load, Hb 136 g/L, neutrophil count 2.0 x 109 no/L and platelets 110 x 109 no/L. He reported anorectal discomfort, specifically haemorrhoids and anal itching, mild anxiety that improved with Lorazepam and mild body itching that improved with the use of emollient creams.
In week 8 of treatment she was admitted to hospital with epigastric pain that became more intense and radiated to both hypochondria during the last 36 hours. She had no fever, chills, nausea, vomiting or choluria. Laboratory tests showed an amylase of 1888 IU/L, Hb 107 g/L, neutrophil count 2.7 x 109 no/L and platelet count 97x109 no/L. Absolute diet (except for taking Telaprevir, with whole milk) and analgesic and antiemetic measures were instituted. The patient progressed favourably and was discharged after one week of hospitalisation with an amylase level of 173 IU/L.
The following day he was admitted again with intense epigastric pain radiating to both hypochondria and an amylase level of 3406 IU/L. Acute pancreatitis was diagnosed. Given the recurrent course (two admissions), Telaprevir was discontinued (week 9 of treatment) due to the possibility that it was the cause and he continued with RBV and P-INF. The patient was discharged five days later with an amylase level of 365 IU/L.
At week 12 post initiation of treatment, viral load was undetectable, Hb 109 g/L, neutrophil count 1.1 x109 no/L and platelet count 1 58x109 no/L. He will continue treatment without Telaprevir until week 24.