Unusual Side Effects of Interferon Beta-1a in Patient with Multiple Sclerosis
A 30-year-old male, resident of Yazd, Iran, was referred to our emergency ward on April 23, 2011, because of massive epistaxis and ecchymosis on arms. He was known as a case of MS and he was getting Rebif (Ares-Serono, Geneva, Switzerland), three days a week, and each time 44mcg subcutaneous, for three months.\nHe had no history of trauma, hematuria, hematochezia, melena, hematemesis, diabetic mellitus, hypertension, ischemic heart disease and hyper lipidemia. The findings in his admission were blood pressure of 102/72 mmHg, pulse rate of 90 beat/min, axillary temperature of 37.2°C and respiratory rate of 24/min. He was oriented to time, place and person. In addition to abnormal CBC and kidney function tests, RBC 2.77mil/cu mm, Hemoglobin (Hgb) 8g/dl, Hematocrite (HCT) 25%, MCV 75fl, platelet count (PLT) 48000, plasma urea 91 mg/dl and creatinine 3.3 mg/dl. PT, PTT and INR were normal. When we hospitalized the patient, routine tests in our unit were checked for him, so they are summarized in Table . We checked retic count that was 0.3%. He didn’t have any significant data In his urine analysis and echocardiography. After that, liver function tests [SGOT (AST)-SGPT (ALT)-ALP], total and direct bilirubin were checked, they were normal. We checked LDH that was 1050 U/L. Infectious diseases such as HIV, HBV, HCV, HSV and EBV serology and ASO were negative. Blood and urine cultures, PPD test, Wright, 2ME were negative, too. Also Direct Coombs and Indirect Coombs were checked. They were negative, too. All investigations for probable malignancies were negative.\nThyroid function tests were normal. CBC, plasma urea and creatinine level were checked again two days later, yet his RBC, Hgb, HCT, MCV, PLT were low (i.e. under normal range) and his plasma urea and creatinine level were high (i.e. above normal range). 24 hours urine with a view to volume, creatinine, urea, uric acid and protein level was checked that was normal. Five days later, his CBC, plasma urea and creatinine level were checked again; RBC 2.88mil/cu mm, Hgb 8.4g/dl, HCT 26.2% and MCV 76fl, plasma urea 91 mg/dl and creatinine 3.2 mg/dl. He was treated with 50mg oral Prednisolone ½ Bid, 50mg Ranitidine IV Bid, one Folic acid tablet Bid, one Vitamin B12 tablet daily. He got 2 IU blood pack cell and Ringer serum 1000 cc/4hrs in the first admission. Peripheral blood smear had severe decrease in number of platelets. Erythrocytes were hypo-chromic severely with mild anisocytosis. White blood cell morphology and count were within normal limit and the most of them were nuetrophils. In bone marrow aspiration, cellularity appeared good (around 50%) and myeloid/erythroid (M/E) ratio was decreased. Blast count was less than 5% of nucleated cells. No dysplasia was detected. Megakaryocytes were increased. In bone marrow biopsy, megakaryocytes were increased. There was no evidence of malignancy. His chest radiograph, pelvic and abdominal sonography was normal. ANA, C3, C4, CH5, c and p ANCA and Anti-dsDNA and serum proteins electrophoresis were in normal range. His kidney biopsy had no significant thing. We consulted with neurologist and she proposed to disconnect interferon beta-1a (Rebif). After all of these investigations, we disconnected Rebif and after two days his CBC, plasma urea and creatinine level were checked again and their results were very fantastic. His RBC, Hgb, HCT, MCV and PLT had started to rise toward normal range, plasma urea and creatinine level had begun to fall. After seven days, they became normal.\nThey are summarized in Table .