An Uncommon Presentation of the Co-Existence of Morphea and Vitiligo in a Patient with Chronic Hepatitis B Virus Infection

Abstract

A 30-year-old man presented with indurated violaceous plaques all over his body that had been present for 7 months. The patient had also had vitiligo for 3.5 years, and hepatitis B virus (HBV) infection and cirrhosis for a 2-year period. Histopathologic examination of the indurated plaques confirmed the diagnosis of morphea. Localized scleroderma and vitiligo have only rarely been reported to occur simultaneously. Although the etiologies of vitiligo and morphea are both uncertain, their association with autoimmune diseases favors an autoimmune hypothesis. Both vitiligo and morphea might have appeared coincidentally. However, this association could be significant because it may be related to the presence of HBV and alterations in the immune system that are caused by this virus. Therefore, this rare combination of vitiligo and morphea in a patient with chronic HBV infection warrants attention because it suggests a possible immunologic association, which may merit future study.

Hepatitis C and hepatitis B virus infections in the etiopathogenesis of pemphigus

“…3,4 Similarly, the mechanisms involved in HBV infection have been proposed as a trigger in some autoimmune diseases such as diabetes mellitus type 1, polyarteritis nodosa and vitiligo. 5,6,7 However, there are few studies that evaluate the relationship between pemphigus and HCV and HBV infections. 8-11 The purpose of this study is to investigate the frequency of HCV and HBV infections in our patients who had recently been diagnosed with pemphigus.…”

Concomitant appearance of morphea and vitiligo in a patient with autoimmune thyroiditis

“…The relation of vitiligo with autoimmune diseases, and detection of organ-specific autoantibodies in vitiligo patients, also the association of particular alleles of the multilocus major histocompatibility complex (MHC) with susceptibility to vitiligo hypothetically suggest that vitiligo is an autoimmune disorder [3, 12, 13]. Although both morphea and vitiligo are autoimmune diseases, concurrent appearance of these entities have rarely been reported [7, 9, 10, 14, 15]. Few reports in the literature have presented cases with MAS [10], cirrhosis [7] and Hashimoto's thyroiditis [9] in patients with both vitiligo and morphea.…”

“…Although both morphea and vitiligo are autoimmune diseases, concurrent appearance of these entities have rarely been reported [7, 9, 10, 14, 15]. Few reports in the literature have presented cases with MAS [10], cirrhosis [7] and Hashimoto's thyroiditis [9] in patients with both vitiligo and morphea. Here, we report a concurrent appearance of vitiligo and morphea, which are two skin diseases of autoimmune origin in a patient with Hashimoto's thyroiditis.…”

Segmental vitiligo with segmental morphea: An autoimmune link?

“…[ 9 ] Based on these findings, an autoimmune basis has been proposed for morphea. [ 10 ] In addition, elevated serum cytokines and cell adhesion molecules have also been related to the immune activation in morphea. [ 11 ] Another mechanism proposed is the decrease in regulatory T-cells contributing to loss of tolerance.…”