Hand-foot syndrome due to hepatitis C therapy

Abstract

SUMMARY INTRODUCTION Direct-acting antivirals are new drugs for chronic hepatitis C treatment. They are usually safe and well tolerated, but can sometimes cause serious adverse effects and there is no consensus on how to treat or prevent them. We described a case of hand-foot syndrome due to hepatitis C virus interferon-free therapy. METHODS We report the case of a 49-year-old man with compensated liver cirrhosis due to chronic hepatitis C genotype 1, treatment-naïve, who started viral treatment with sofosbuvir, simeprevir and ribavirin for 12 weeks. RESULTS At the sixth week of treatment he had anemia, requiring a lower dose of ribavirin. At the tenth week, he had erythematous, pruritic, scaly and flaky lesions on hands and feet, which showed a partial response to oral antihistamines and topical corticosteroids. It was not necessary to discontinue antiviral treatment, but in the first week after the end of treatment, there was worsening of injuries, including signs of secondary infection, that required hospitalization, antibiotics and oral corticosteroid, with progressive improvement. Biopsy of the lesions was consistent with pharmacodermia. The patient had sustained a virological response, despite the side effect. He had a history of pharmacodermia one year ago attributed to the use of topiramate, responsive to oral corticosteroid. CONCLUSION Interferon-free therapies can rarely lead to severe adverse reactions, such as skin lesions. Patients receiving ribavirin combinations and those who had a history of pharmacodermia or skin disease may be more susceptible. There is no consensus on how to prevent skin reactions in these patients.

Eczematous Drug Eruption Induced by Sofosbuvir/Velpatasvir: The Need for a Better Classification

“…Little is known about second-generation DAAs skin AEs because clinical trials do not differentiate between types of skin “rashes” and the causes for drug discontinuation. 1 Isolated cases of leucocytoclasic vasculitis, 8 pityriasis rubra pilaris-like drug eruption, 9 Steven-Johnson Syndrome, 10 hand–foot syndrome, 11 erythema multiforme, 12 and photoinduced drug eruption 13,14 have been reported with sofosbuvir, alone or in combination with other DAAs.…”