Interferon-induced parkinsonism in a patient with chronic hepatitis C

A 65-year-old female patient, diagnosed 2 years prior with chronic hepatitis C, genotype 3, and probably infected via a blood transfusion performed 16 years earlier, presented to the Fundacao de Medicina Tropical do Amazonas complaining of in-tense fatigue. She presented a Fatigue Severity Scale score of 4. 1 points. She was hypertensive and was under continuous treat-ment with propranolol. The patient had no history of neurolog-ical disease. Treatment was started with Peg-IFN-α 2a (180 µg/week) plus ribavirin (1 g/day). After exactly 2 months of using this medication, she presented symmetrical stiffness in the up-per limbs and low-frequency tremors at rest and posture. The results of the cognitive and postural examinations, as well as the deep tendon reflexes and the cranial nerves, were normal. Nevertheless, the treatment was suspended. At approximately two months after the discontinuation of the treatment, an MRI of the brain was performed, and the results were normal. Labo-ratory tests to determine the levels of thyroid-stimulating hor-mone, tetraiodothyronine, copper and ceruloplasmin all yield-ed normal results, and serology for HIV was negative. However, the patient continued to present tremors and rigidity. Treatment with the levodopa-benserazide combination was started with 125 mg/day, and the dose was gradually increased up to 250 mg/day. Partial improvement of the tremors and upper-limb rigidity was observed. At this writing, the patient remained under treat-ment with levodopa.