Adverse Skin Reactions due to Ribavirin in Hepatitis C Combination Therapy with Pegylated Interferon-α2a
We describe a 59-year-old Japanese woman with a chronic hepatitis C infection who developed erythema during PEG-IFN-α2a and ribavirin therapy. There was a faint erythema on her trunk and her arms after 8 weeks of treatment (week 8). Administration of bepotastine besilate had no effect. However, the erythema improved with the application of crotamiton cream and alclometasone dipropionate ointment. Fluvastatin sodium was added for her hypercholesterolemia at week 12. The HCV RNA virus had decreased from 6.6 logIU/ml to negative at week 16. Subcutaneous injection of PEG-IFN-α2a was postponed due to recurrent erythema at week 20. Eruption at the injection site of IFN occurred after each injection, and then, eruption on her head, face and neck (exposed skin) was observed (fig. ). Twenty milligrams of prednisolone was administered. After each administration of prednisolone and ribavirin, the eruption recurred. The eruption consisted of red papules fused to an erythematous plaque. After PEG-IFN-α2a subcutaneous injection in her right arm, the eruptions became worse and she had a consultation in our department. At that time, she had infiltrative erythema without any mucosal symptoms on her whole body (fig. ). It seemed to be an erythema multiforme type drug eruption of PEG-IFN-α2a, ribavirin and/or fluvastatin sodium from the clinical course. Although administration of all drugs was stopped, the eruption expanded after administering 40 mg prednisolone and a topical steroid. Since prednisolone was suspected to have been the cause of the drug eruption, the eruption improved after it was changed to 6 mg of betamethasone.\nThe HCV RNA virus was negative at week 17. However, it had increased to 6.8 logIU/ml at week 28.\nThe lymphocyte transformation test (LTT) was carried out for PEG-IFN-α2a, ribavirin and fluvastatin sodium. Only ribavirin was positive.