High fever and arrhythmia that emerged after drinking alcohol in a patient with chronic hepatitis C under treatment with ledipasvir/sofosbuvir

Abstract

A 71-year-old man without a history of heavy drinking was referred to our hospital for anti-viral treatment against chronic hepatitis C with genotype 1 virus infection, and the therapy with ledipasvir and sofosbuvir was started. Five days after the start of the therapy, he drank approximately 1500 ml of beer. In the early morning of the next day, he suffered high fever and arrhythmia. Elevation of WBC with neutrophilia and slight elevation of CRP were observed without deterioration of liver function tests. Symptoms of high fever and arrhythmia disappeared within one day. The therapy was continued for 12 weeks, and sustained virologic response at 12 week from the end of treatment (SVR12) was achieved. Mechanism of high fever and arrhythmia could not be determined, however, there is a possibility that alcohol intake under the treatment of ledipasvir and sofosbuvir may have some relation with these symptoms.