Peginterferon-α-2b/ribavirin

Reactions 1291 - 6 Mar 2010 S Peginterferon-α-2b/ribavirin Skin eruptions in an elderly patient?: case report A 73-year-old man with hepatitis C virus (HCV) infection developed recurring skin eruptions following treatment with peginterferon-α-2b and ribavirin [frequency of administration not stated]. The man started receiving peginterferon-α-2b 100µg injections and ribavirin 800mg in February 2006; before treatment was withdrawn due to worsening transaminase levels on 25 July 2006, his peginterferon dosage was decreased to 80µg, and ribavirin was tapered to 600mg and later 400mg [timelines not clearly stated]. Peginterferon was only injected into his upper arms, and he experienced expected injection site reactions during treatment. In October 2006, he first developed round pruritic erythematous plaques in femoral areas, which spontaneously resolved after 1 week. However, skin lesions recurred about once every month; additionally, his HCV DNA levels increased prior to the first episode, and remained elevated for approximately the next 11 months, normalising about 3 months after the sixth episode. During every episode, his skin lesions were mainly confined to the same area, but then gradually spread to his trunk. He developed fever during the fourth episode, and the lesions spread to his arms. In mid March 2007, he experienced a fifth episode, with additional blisters and erosions. On presentation, dark reddish, round erythematous plaques and rare flaccid blisters were noted predominantly on his trunk, proximal limbs, penis and lower lip. Erythema multiforme was diagnosed, and he was hospitalised. A skin biopsy from his left forearm showed well-demarcated foci of epidermal necrosis with subepidermal bullae, lymphoid exocytosis and a perivascular mainly lymphocytic inflammatory infiltrate. Drug lymphocyte stimulation tests were negative for peginterferon- α-2b and ribavirin. The man started receiving prednisolone, and his skin lesions promptly resolved with residual pigmented macules. However, he developed a high fever 7 days after prednisolone discontinuation, and erythematous, blistered plaques at previous lesion sites recurred. Fixed drug eruption was diagnosed after the sixth episode, and systemic prednisolone was restarted. The lesions quickly resolved, leaving residual pigmentation. His therapy was subsequently changed to interferon-α, and his skin lesions had not recurred during the following year. Author comment: "It is still not conclusive whether the present case represented a prolonged drug rash provoked by pegylated IFN-a-2b and ribavirin combination therapy, or a fixed eruption in response to another antigen. We favour the former possibility, although it is not clear exactly what prompted the series of recurrences beginning 3 months after the pegylated IFN-a-2b/ribavirin was discontinued." Sato M, et al. Repeated episodes of fixed eruption 3 months after discontinuing pegylated interferon-alpha-2b plus ribavirin combination therapy in a patient with chronic hepatitis C virus infection. Clinical and Experimental Dermatology 34: e814-e817, No. 8, Dec 2009. Available from: URL: http://dx.doi.org/10.1111/ j.1365-2230.2009.03560.x - Japan 803006745 1 Reactions 6 Mar 2010 No. 1291 0114-9954/10/1291-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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Transcript of Peginterferon-α-2b/ribavirin

Reactions 1291 - 6 Mar 2010

SPeginterferon-α-2b/ribavirin

Skin eruptions in an elderly patient?: case reportA 73-year-old man with hepatitis C virus (HCV) infection

developed recurring skin eruptions following treatment withpeginterferon-α-2b and ribavirin [frequency of administrationnot stated].

The man started receiving peginterferon-α-2b 100µginjections and ribavirin 800mg in February 2006; beforetreatment was withdrawn due to worsening transaminaselevels on 25 July 2006, his peginterferon dosage wasdecreased to 80µg, and ribavirin was tapered to 600mg andlater 400mg [timelines not clearly stated]. Peginterferon wasonly injected into his upper arms, and he experiencedexpected injection site reactions during treatment. InOctober 2006, he first developed round pruritic erythematousplaques in femoral areas, which spontaneously resolved after1 week. However, skin lesions recurred about once everymonth; additionally, his HCV DNA levels increased prior to thefirst episode, and remained elevated for approximately thenext 11 months, normalising about 3 months after the sixthepisode. During every episode, his skin lesions were mainlyconfined to the same area, but then gradually spread to histrunk. He developed fever during the fourth episode, and thelesions spread to his arms. In mid March 2007, he experienceda fifth episode, with additional blisters and erosions. Onpresentation, dark reddish, round erythematous plaques andrare flaccid blisters were noted predominantly on his trunk,proximal limbs, penis and lower lip. Erythema multiforme wasdiagnosed, and he was hospitalised. A skin biopsy from his leftforearm showed well-demarcated foci of epidermal necrosiswith subepidermal bullae, lymphoid exocytosis and aperivascular mainly lymphocytic inflammatory infiltrate. Druglymphocyte stimulation tests were negative for peginterferon-α-2b and ribavirin.

The man started receiving prednisolone, and his skin lesionspromptly resolved with residual pigmented macules.However, he developed a high fever 7 days after prednisolonediscontinuation, and erythematous, blistered plaques atprevious lesion sites recurred. Fixed drug eruption wasdiagnosed after the sixth episode, and systemic prednisolonewas restarted. The lesions quickly resolved, leaving residualpigmentation. His therapy was subsequently changed tointerferon-α, and his skin lesions had not recurred during thefollowing year.

Author comment: "It is still not conclusive whether thepresent case represented a prolonged drug rash provoked bypegylated IFN-a-2b and ribavirin combination therapy, or afixed eruption in response to another antigen. We favour theformer possibility, although it is not clear exactly whatprompted the series of recurrences beginning 3 months afterthe pegylated IFN-a-2b/ribavirin was discontinued."Sato M, et al. Repeated episodes of fixed eruption 3 months after discontinuingpegylated interferon-alpha-2b plus ribavirin combination therapy in a patient withchronic hepatitis C virus infection. Clinical and Experimental Dermatology 34:e814-e817, No. 8, Dec 2009. Available from: URL: http://dx.doi.org/10.1111/j.1365-2230.2009.03560.x - Japan 803006745