Rare Skin Manifestation of Hepatitis C Infection

Abstract

Introduction: This is a case of a 19-year-old African American female who presented with a skin rash of 6 months’ duration. The patient denied history of intravenous drug use, blood transfusion. He has a history of tattoo 3 years prior to presentation. Her family history is significant for hepatitis C and HIV infection in the mother. The skin lesion started on bilateral lower extremities and progressed to involve her hands. Initially started as erythematous plaques, which progressively became darker, bigger, and scaly with associated itching. Her past medical and surgical history was unremarkable. She has no known drug allergies. Home medications include Lindex and flucisonide cream, hydroxyzine, and Benadryl oral tablets as needed. She smokes 3 cigarettes per day and drinks about 1 drink every 3-4 weeks. On physical examination, the patient had hyperpigmented, hyperkeratotic, lichenified plaques on hands and ankles bilaterally, with the lesions on the feet being more pronounced. The remainder of the physical examination was unremarkable. Labs significant for hepatitis C, elevated bilirubin, AST, and ALT. Skin biopsy was done and the lesion was found out to be necrolytic acral erythema, a rare skin manifestation of hepatitis C infection that occurs in dark-skin patients. The patient was started with hepatitis C treatment but lost to follow-up. Atypical skin lesions, which persist in black patients, warrant investigation to look for hepatitis C infection, as the early detection and treatment will prevent subsequent morbidity and mortality.Figure 1Figure 2Figure 3