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The man started receiving peginterferon-α-2b 100µginjections and ribavirin 800mg in February 2006; beforetreatment was withdrawn due to worsening transaminaselevels on 25 July 2006, his peginterferon dosage wasdecreased to 80µg, and ribavirin was tapered to 600mg andlater 400mg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

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Reactions 6 Mar 2010 No. 12910114-9954/10/1291-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved