Leukocytoclastic vasculitis caused by hepatitis C virus in a liver transplant recipient: A case report

• 作者: Amanda de Castro Machado Andre Luis Conde Watanabe Fernando Marcus Felippe Jorge Gabriela de Campos Araujo Gustavo de Sousa Arantes Ferreira Luiz Gustavo Guedes Diaz Milla Carolina Costa Lafeta Araujo Natalia de Carvalho Trevizoli
• 来源期刊: 世界肝病学杂志:英文版(电子版)
• 学科: 医学
• 关键词: Hepatitis C Liver transplantation Leukocytoclastic VASCULITIS IMMUNOSUPPRESSION Direct-acting ANTIVIRALS Case report
• 年，卷（期）: 2019,（4）
• 页码范围: 402-408
• 页数: 7页
• 分类号: R

摘要

BACKGROUND Infection by the hepatitis C virus (HCV) is currently considered to be a global health issue, with a high worldwide prevalence and causing chronic disease in afflicted individuals. The disease largely involves the liver but it can affect other organs, including the skin. While leukocytoclastic vasculitis has been reported as one of the dermatologic manifestations of HCV infection, there are no reports of this condition as the first symptom of HCV recurrence after liver transplantation. CASE SUMMARY We report here a case of leukocytoclastic vasculitis in a liver transplant recipient on maintenance immunosuppression. The condition presented as a palpable purpura in both lower extremities. Blood and urine cultures were negative and all biochemical tests were normal, excepting evidence of anemia and hypocomplementemia. Imaging examination by computed tomography showed a small volume of ascites, diffuse thickening of bowel walls, and a small bilateral pleural effusion. Skin biopsy showed leukocytoclasia and fibrinoid necrosis. Liver biopsy was suggestive of HCV recurrence in the graft, and HCV polymerase chain reaction yielded 11460 copies/mL and identified the genotype as 1A. Treatment of the virus with a 12-wk direct-acting antiviral regimen of ribavirin, sofosbuvir and daclatasvir led to regression of the symptoms within the first 10 d and subsequent complete resolution of the symptoms. CONCLUSION This case highlights the difficulties of diagnosing skin lesions caused by HCVinfection in immunosuppressed patients.