This is a 62 year old male with previously diagnosed cirrhosis secondary to a combination of genotype 3 hepatitis C virus and alcohol. He is status post a live donor liver transplantation five years ago from a family member. Five years prior to his transplant, he had been treated with interferon and ribavirin for hepatitis C for 24 weeks and was a responder/relapser. The patient's treatment course at that time was complicated by intense feelings of rage. The patient was subsequently maintained on low dose PEG-Interferon monotherapy for viral suppression for approximately one year and did not experience any feelings of rage. He was then off of treatment for several years prior to undergoing liver transplantation.
One year post transplant, he underwent a liver biopsy that revealed mild steatosis, patchy glycogenated hepatocytic nuclei, prominent Kupffer cells, mild lobular and portal chronic inflammation, and rare acidophil bodies consistent with a minimal grade hepatic process (grade 0-1/4), with no fibrosis seen (stage 0/4). Given that he was stage 0, he preferred to wait on treatment of his HCV as he had a difficult time with the side effects of his previous treatment. His HCV RNA level was 7,200,000 IU/mL at that time.
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