Necrolytic acral erythema in a human immunodeficiency virus/hepatitis C virus coinfected patient: A case report

Table 1 Basic laboratory findings

Parameters	Reference range
White blood cell count - 15.3	4.5-11 K/uL
Hematocrit - 44.5	34%-47%
Hemoglobin – 13.6	11.7-15 g/dL
Platelet count – 376000	150-450 K/uL
Blood urea nitrogen - 42	7-20 mg/dL
Creatinine – 1.28	0.5-1.1 mg/dL
AST - 17	< 36 U/L
ALT - 23	< 46 U/L
Total bilirubin - 2.0	0.1-1.2 mg/dL
Direct bilirubin – 1.0	< 0.9 mg/dL
gGT - 145	0-60 IU/L
Total protein – 6.4	6-8.3 g/dL
Albumin – 2.6	3.5-5.0 g/dL
Erythrocyte Sedimentation rate - 68	(0-24 mm/h)
C-reactive protein – 78.32	< 5.1 mg/L
INR – 1.0	0.9-1.1
C3 - 156	90-180 mg/dL
cANCA - negative	Negative
pANCA - negative	Negative
Rheumatoid factor - < 15	0-15 IU/mL
Anti-SSA – negative	Negative
Anti-SSB – negative	Negative
Anti-CCP – negative	Negative
RPR – non-reactive	Non-reactive
Cryoglobulins – negative	Negative
Antinuclear antibodies - negative	Negative
AntidsDNA – negative	Negative
HIV RNA – undetectable	< 20 copies/mL
CD4 – 564/25%	Cells/mL
HCV-RNA – 346755 genotype 1B	< 15 IU/mL

HCV: Hepatitis C virus; HIV: Human immunodeficiency virus; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; INR: International normalized ratio; cANCA: Cytoplasmic anti-neutrophil cytoplasmic antibody; pANCA: Perinuclear anti-neutrophil cytoplasmic antibody; CCP: Cyclic citrullinated peptides; RPR: Rapid plasma regain.

Table 2 Literature review – cases of necrolytic acral erythema

	HCV	HIV	Zinc deficiency	Diagnosis	Treatment
Srisuwanwattana et al[1]	Yes	NA	No	Skin biopsy	Zinc supplementation and topical steroids
Kapoor et al[2]	Yes	NA	Yes	Clinical diagnosis	Oral zinc supplementation
Jakubovic et al[3]	No	NA	Yes	Skin biopsy	Nutritional Supplementation
Abdallah et al[5]	Yes	NA	No	Skin biopsy	Zinc supplementation
Pernet et al[7]	No	NA	No	Skin biopsy	Resolved spontaneously
Tabibian et al[8] Case 1	Yes	NA	Yes	Skin biopsy	Zinc supplementation
Tabibian et al[8] Case 2	Yes	NA	Yes	Skin biopsy	Zinc supplementation
Das et al[9]	No	NA	NA	Skin biopsy	Zinc supplementation
Najarian et al[12]	Yes	Yes	Yes	Skin biopsy	Zinc supplementation
Shumez et al[15]	Yes	NA	Yes	Skin biopsy	Zinc supplementation
Shaikh et al[16]	Yes	NA	No	Skin biopsy	Ledipasvir/sofosbuvir
Wu et al[17]	No	NA	NA	Skin biopsy	Systemic steroids
Rahman et al[18]	Yes	NA	NA	Skin biopsy	Systemic steroids and zinc supplementation
Botelho et al[19]	Yes	NA	Yes	Skin biopsy	Zinc supplementation
Panta et al[20]	No	NA	Low normal levels	Skin biopsy	Oral zinc supplementation and topical steroids
Pandit et al[21] Case 1	No	NA	Yes	Skin biopsy	Oral zinc supplementation
Pandit et al[21] Case 2	No	NA	Yes	Clinical diagnosis	Oral zinc supplementation

NA: Not available; HCV: Hepatitis C virus; HIV: Human immunodeficiency virus.