Published online Apr 27, 2019. doi: 10.4254/wjh.v11.i4.402
Peer-review started: January 18, 2019
First decision: March 5, 2019
Revised: March 16, 2019
Accepted: April 8, 2019
Article in press: April 8, 2019
Published online: April 27, 2019
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.
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.
This case highlights the difficulties of diagnosing skin lesions caused by HCV infection in immunosuppressed patients.
Core tip: Leukocytoclastic vasculitis is an uncommon extrahepatic manifestation of infection by the hepatitis C virus (HCV). We report the case of a patient who underwent liver transplantation for the treatment of cirrhosis and hepatocellular carcinoma associated with HCV infection, and who developed skin lesions and systemic symptoms, such as fever, post-transplantation. A short time after HCV antiviral treatment was started, the patient showed complete regression of all symptoms. While there are previous reports of leukocytoclastic vasculitis in solid organ transplant recipients, we have found no previous case in the literature of this being a symptom of HCV recurrence in this context.