Successful Treatment of Oral Lichen Planus with Direct-Acting Antiviral Agents after Liver Transplantation for Hepatitis C Virus-Associated Hepatocellular Carcinoma

Abstract

Hepatitis C virus (HCV) infection is frequently associated with various extrahepatic manifestations, such as autoimmune features and immune complex deposit diseases. Oral lichen planus (OLP) is one such extrahepatic manifestation of HCV infection. Recently, direct-acting antivirals (DAA) have proved to be highly effective and safe for the eradication of HCV. Herein, we report a case of OLP accompanied by HCV-related hepatocellular carcinoma (HCC) that disappeared after liver transplantation and achievement of sustained virological response following interferon (IFN)-free treatment with ledipasvir (LDV) and sofosbuvir (SOF). The 50-year-old patient developed erosive OLP during IFN therapy, with hyperthyroidism at 53 years of age and HCC at 55 years. He received immunosuppressive drugs and IFN-free DAA treatment after liver transplantation at 60 years of age, which led to disappearance of the symptoms of OLP. The patient was treated safely and effectively with LDV/SOF, although it is not known whether the disappearance of OLP resulted from the eradication of HCV or the immunosuppressive therapy.

Three cases of incident lichen planus after direct-acting antiviral treatment for hepatitis C

“…In contrast to our patients, several cases published in the literature describe patients whose LP improved or resolved after treatment with DAA. 7 , 8 , 9 , 10 , 11 Perhaps the pathogenesis of LP in our patients differs from that of these patients, or perhaps the immunopathogenic drivers of LP in the setting of HCV lag behind treatment or are exacerbated by treatment in some cases. It is also possible our patients' LP was unrelated to HCV or its treatment.…”

“… 3 However, limited data exist regarding outcomes of HCV-associated skin disease after DAA treatment. Case reports and series have documented HCV-associated cryoglobulinemic vasculitis, 4 porphyria cutanea tarda, 5 and oral and cutaneous LP 6 , 7 , 8 , 9 , 10 improving or resolving after DAA treatment. Conversely, new-onset LP developing 3 months after HCV treatment with elbasvir-grazoprevir was recently described, 11 and a patient with pre-existing oral LP who had new cutaneous LP after treatment with ledipasvir-sofosbuvir was also reported.…”

Prevalence of Viral Liver Disease and Oral Lichen Planus in Patients Who Visited Dental Clinics: A Study by the Ehime Dental Association

“…We showed that, of patients with OLP, 62% had HCV antibodies and 60% had HCV RNA in their serum [11]. Furthermore, there is evidence that treatment with DAAs improves OLP associated with HCV-related infection [12][13][14][15].…”

Hepatitis C virus-associated hepatocellular carcinoma after sustained virologic response

“…They reported that HCV eradication after DAA therapy involves immune reconstitution[50]. These immune reconstitutions may support the successful treatment of oral lichen planus after DAA therapy[51]. Thus, rapid immunological changes, including in NKG2D systems are observed during and after DAA treatment, and they may have several effects on HCC occurrence and recurrence.…”