A case of type C chronic hepatitis with constitutional hyperbilirubinemia treated by peginterferon-alpha + ribavirin + simeprevir

We reported a case of a 42-y/o man with constitutional hyperbilirubinemia and type C chronic hepatitis treated by peginterferon-alpha + ribavirin + simeprevir. His serum TB level was increased (from 2.5 to 8.1 mg/ dL 3 w after treatment), but gradually decreased thereafter (5.1 mg/dL 4 w after treatment), and recovered (3.0 mg/dL) 4 w after stopping simeprevir. HCV-RNA has been negative and liver function has been normal after treatment. He did not have either any symptom or abnormality in laboratory data except TB level during the treatment. Simeprevir was reported to sometimes increase serum TB level. In this case, organic anion- transporting polypeptide 1B1 (OATP1B1) seems to be inhibited by simeprevir, because the increase in indirect bilirubin was dominant. This case suggests that the treatment for type C chronic hepatitis with simeprevir is possible even in patients with constitutional hyperbilirubinemia, because the increase in serum TB level was temporal and recovered after stopping simeprevir.