A 56-year-old male patient with
chronic hepatitis C was treated with pegylated
interferon (PEG IFN)-α-2b and
ribavirin (RBV) for 72 weeks in 2006. The patient achieved an early virological response (EVR); however,
hepatitis C relapsed 12 weeks after discontinuation of PEG IFN and RBV. In 2012, the patient was treated with a PEG IFN/RBV/
telaprevir combination
therapy. After 5 days of treatment, he suffered from a
telaprevir-associated
skin rash on his body and four limbs. He chose to be treated with PEG IFN and RBV until 60 weeks. He again achieved EVR but no sustained virological response. In 2014, he was treated with PEG IFN/RBV/
simeprevir combination
therapy. He achieved rapid virological response, but after 6 weeks of
therapy, a striking elevation of serum
aminotransferase level was recorded with no accompanying
skin rash; he was admitted to our hospital. PEG IFN/RBV/
simeprevir was stopped, but
sodium valproate (400 mg/day), which had been administrated for more than 10 years to prevent
epilepsy was continued. Liver biopsy revealed typical features of
drug-induced liver injury. After stopping PEG IFN/RBV/
simeprevir, serum
aminotransferase levels soon returned to the normal range. We diagnosed this case to be
simeprevir-induced
hepatitis clinically and histologically. Physicians need to stay alert to the possibility of
drug-induced liver injury in using
simeprevir.