Pellicelli AM, Morrone A, Barbieri L, Andreoli A

Language: English
References: 15
Page: 951-954
PDF size: 145.39 Kb.

ABSTRACT

Introduction. Porphyria cutanea tarda (PCT) is the most common type of porphyria. The strong association between PCT and hepatitis C virus (HCV) infection is well established. Although antiviral treatment of chronic hepatitis C may improve PCT in some cases, de novo onset of PCT has been observed in patients undergoing peginterferon/ribavirin treatment. We present a rare case of a genotype 3 HCV-positive liver transplant recipient who developed PCT during antiviral treatment and discuss its probable etiopathogenesis. Case presentation. A genotype 3 HCV-positive liver transplant recipient, a 42-year-old man, was treated with peginterferon alfa-2a (180 µg/week) combined with ribavirin (1,200 mg/day) for recurrence of HCV infection after liver transplantation. He presented with hyperferritinemia but tested negative for genetic hemochromatosis (C282Y and H63D mutations). During antiviral therapy, he developed skin lesions on his hands characterized by vesicles and erosions consistent with PCT. PCT was confirmed by skin biopsy and elevated urinary uroporphyrin levels (1,469 mg/24 h). He was treated with chloroquine (200 mg) twice weekly, resulting in gradual regression of the skin lesions. Antiviral treatment was stopped after 48 weeks, and the patient achieved a sustained virological response. In conclusion, we report an extremely rare case of PCT in a genotype 3 HCV-positive liver transplant patient treated with antiviral therapy. We believe that the combination of HCV genotype 3 infection; hemolysis due to ribavirin treatment; and increased plasma levels of cytokines, such as IL-6 and TNFα, could have altered the patient’s iron metabolism and thus caused PCT.

REFERENCES

1. Gisbert JP, García-Buey L, Pajares JM, Moreno-Otero R. Prevalence of hepatitis C virus infection in porphyria cutanea tarda: systematic review and meta-analysis. J Hepatol 2003; 39: 620-7.

2. Bonkovsky HL, Poh-Fitzpatrick M, Pimstone N, Obando J, Di Bisceglie A, Tattrie C, Tortorelli K, et al. Porphyria cutanea tarda, hepatitis C, and HFE gene mutations in North America. Hepatology 1998; 27: 1661-9.

3. Okano J, Horie Y, Kawasaki H, Kondo M. Interferon treatment of porphyria cutanea tarda associated with chronic hepatitis C. Hepatogastroenterology 1997; 44: 525-8.

4. Sheikh MY, Wright RA, Burruss JB. Dramatic resolution of skin lesions associated with porphyria cutanea tarda after interferon-alpha therapy in a case of chronic hepatitis C. Dig Dis Sci 1998; 43: 529-33.

5. Siegel LB, Eber BB. Porphyria cutanea tarda remission. Ann Intern Med 1994; 121: 308-9.

6. Takikawa H, Yamazaki R, Shoji S, Miyake K, Yamanaka M. Normalization of urinary porphyrin level and disappearance of skin lesion after successful interferon therapy in a case of chronic hepatitis C complicated with porphyria cutanea tarda. J Hepatol 1995; 22: 249-50.

7. Thevenot T, Bachmeyer C, Hammi R, Dumouchel P, Ducamp- Posak I, Cadranel JF. Occurrence of porphyria cutanea tarda during peginterferon/ribavirin therapy for chronic viral hepatitis C. J Hepatol 2005; 42: 607-8.

8. Jessner W, Der-Petrossian M, Christiansen L, Maier H, Steindl-Munda P, Gangl A, Ferenci P. Porphyria cutanea tarda during interferon/ribavirin therapy for chronic hepatitis C. Hepatology 2002; 36: 1301-2.

9. Frider B, Buonsante ME, Tiscornia J, Alessio A, Pellerano G. Development of porphyria cutanea tarda in a chronic hepatitis C patient with indetectable viremia under treatment with peg-interferon plus ribavirin. Acta Gastroenterol Latinoam 2006; 36: 38-41.

10. Sebastiani G, Vario A, Ferrari A, Pistis R, Noventa F, Alberti A. Hepatic iron, liver steatosis and viral genotypes in patients with chronic hepatitis C. J Viral Hep 2006; 13: 199-205.

11. Fujita N, Sugimoto R, Motonishi S, Tomosugi N, Tanaka H, Takeo M, et al. Patients with chronic hepatitis C achieving a sustained virological response to peginterferon and ribavirin therapy recover from impaired hepcidin secretion. J Hepatol 2008; 49: 702-10.

12. Lin TJ, Liao LY, Chou JM, Liu SO, Wang CK. Serum prohepcidin levels correlate with hepatic iron stores in chronic hepatitis C patients. Hepatogastroenterology 2009; 56: 1146-51.

13. Pietrangelo A. Hepcidin in human iron disorders: therapeutic implications. J Hepatol 2011; 54: 173-81.

14. Sypniewski D, Jurzak M, Cholewa K, Gola J, Mazurek U, Wilczok T, et al. Changes in TNF-alpha mRNA levels in the peripheral blood of patients with chronic hepatitis C virus (HCV) infection during alpha-interferon and ribavirin therapy. Viral Immunol 2004; 17: 580-7.

15. Azim J, McCurdy H, Moseley RH. Porphyria cutanea tarda as a complication of therapy for chronic hepatitis C. World J Gastroenterol 2008; 14: 5913-5.