Case 10-2011: Fever, Confusion, and Liver Failure

To the Editor: With regard to the Case Record of a 60-year-old woman with fever, confusion, and liver failure (March 31 issue) 1 : we are interested in Tierney's thoughts on the possibility that the combined use of pegylated interferon and ribavirin to treat the patient's hepatitis C induced an autoimmune liver disease that contributed to her death. 2 , 3 Her confusion and asterixis (suggesting hepatic encephalopathy), the markedly elevated levels of transaminases and the associated positive test result for autoimmune markers, and the response to glucocorticoids lead us to suspect a diagnosis of autoimmune liver disease. We are also curious as . . .