Oikonomou KG, Sarpel D, Abrams-Downey A, Mubasher A, Dieterich DT. Necrolytic acral erythema in a human immunodeficiency virus/hepatitis C virus coinfected patient: A case report. World J Hepatol 2019; 11(2): 226-233 [PMID: 30820272 DOI: 10.4254/wjh.v11.i2.226]
Corresponding Author of This Article
Katerina G Oikonomou, MD, PhD, Academic Fellow, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, Mount Sinai St Luke’s-West, 1111 Amsterdam Avenue, S and R 13, New York, NY 10025, United States. katerina.oikonomou@mountsinai.org
Research Domain of This Article
Gastroenterology & Hepatology
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Case Report
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Oikonomou KG, Sarpel D, Abrams-Downey A, Mubasher A, Dieterich DT. Necrolytic acral erythema in a human immunodeficiency virus/hepatitis C virus coinfected patient: A case report. World J Hepatol 2019; 11(2): 226-233 [PMID: 30820272 DOI: 10.4254/wjh.v11.i2.226]
World J Hepatol. Feb 27, 2019; 11(2): 226-233 Published online Feb 27, 2019. doi: 10.4254/wjh.v11.i2.226
Necrolytic acral erythema in a human immunodeficiency virus/hepatitis C virus coinfected patient: A case report
Katerina G Oikonomou, Dost Sarpel, Alexandra Abrams-Downey, Adnan Mubasher, Douglas T Dieterich
Katerina G Oikonomou, Dost Sarpel, Alexandra Abrams-Downey, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, Mount Sinai St Luke’s-West, New York, NY 10025, United States
Adnan Mubasher, Department of Pathology, Icahn School of Medicine at Mount Sinai, Mount Sinai St Luke’s-West, New York, NY 10025, United States
Douglas T Dieterich, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Author contributions: Oikonomou KG manuscript preparation, clinical data collection and literature search and review; Sarpel D clinical data and literature review, critical review of the manuscript, clinical images preparation; Abrams-Downey A clinical data and literature review, critical review of the manuscript, clinical images preparation; Mubasher A pathology slides review and histologic description of the biopsy samples, pathology images/photomicroscopy preparation; Dieterich DT critical review of manuscript, clinical data and literature review.
Informed consent statement: Consent was obtained from patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Katerina G Oikonomou, MD, PhD, Academic Fellow, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, Mount Sinai St Luke’s-West, 1111 Amsterdam Avenue, S and R 13, New York, NY 10025, United States. katerina.oikonomou@mountsinai.org
Telephone: +1-212-5232525 Fax: +1-212-5233931
Received: October 16, 2018 Peer-review started: October 16, 2018 First decision: November 15, 2018 Revised: December 13, 2018 Accepted: January 9, 2019 Article in press: January 9, 2019 Published online: February 27, 2019 Processing time: 133 Days and 19.1 Hours
Abstract
BACKGROUND
Necrolytic acral erythema (NAE) is a rare dermatological disorder, which is associated with hepatitis C virus (HCV) infection or zinc deficiency. It is characterized by erythematous or violaceous lesions occurring primarily in the lower extremities. The treatment includes systemic steroids and oral zinc supplementation. We report a case of NAE in a 66-year-old human immunodeficiency virus (HIV)/HCV co-infected woman with NAE. NAE is rarely reported in co-infected patients and the exact mechanisms of pathogenesis are still unclear.
CASE SUMMARY
A 66-year-old HIV/HCV co-infected female patient presented with painless, non-pruritic rash of extremities for one week and underwent extensive work-up for possible rheumatologic disorders including vasculitis and cryoglobulinemia. Punch skin biopsies of right and left thigh revealed thickened parakeratotic stratum corneum most consistent with NAE. Patient was started on prednisone and zinc supplementation with resolution of the lesions and improvement of rash.
CONCLUSION
Clinicians should maintain high clinical suspicion for early recognition of NAE in patients with rash and HCV.
Core tip: Necrolytic acral erythema (NAE) is a rare dermatological entity associated with hepatitis C virus (HCV) and zinc deficiency. Aim of the case report is to describe the occurrence of NAE in a human immunodeficiency virus/HCV coinfected patient, elucidate the clinical characteristics, pathophysiologic mechanisms and increase clinician awareness about diagnosis and management.
