Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2019; 11(2): 226-233
Published online Feb 27, 2019. doi: 10.4254/wjh.v11.i2.226
Necrolytic acral erythema in a human immunodeficiency virus/hepatitis C virus coinfected patient: A case report
Katerina G Oikonomou, Dost Sarpel, Alexandra Abrams-Downey, Adnan Mubasher, Douglas T Dieterich
Katerina G Oikonomou, Dost Sarpel, Alexandra Abrams-Downey, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, Mount Sinai St Luke’s-West, New York, NY 10025, United States
Adnan Mubasher, Department of Pathology, Icahn School of Medicine at Mount Sinai, Mount Sinai St Luke’s-West, New York, NY 10025, United States
Douglas T Dieterich, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Author contributions: Oikonomou KG manuscript preparation, clinical data collection and literature search and review; Sarpel D clinical data and literature review, critical review of the manuscript, clinical images preparation; Abrams-Downey A clinical data and literature review, critical review of the manuscript, clinical images preparation; Mubasher A pathology slides review and histologic description of the biopsy samples, pathology images/photomicroscopy preparation; Dieterich DT critical review of manuscript, clinical data and literature review.
Informed consent statement: Consent was obtained from patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Katerina G Oikonomou, MD, PhD, Academic Fellow, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, Mount Sinai St Luke’s-West, 1111 Amsterdam Avenue, S and R 13, New York, NY 10025, United States. katerina.oikonomou@mountsinai.org
Telephone: +1-212-5232525 Fax: +1-212-5233931
Received: October 16, 2018
Peer-review started: October 16, 2018
First decision: November 15, 2018
Revised: December 13, 2018
Accepted: January 9, 2019
Article in press: January 9, 2019
Published online: February 27, 2019
Processing time: 133 Days and 19.1 Hours
Abstract
BACKGROUND

Necrolytic acral erythema (NAE) is a rare dermatological disorder, which is associated with hepatitis C virus (HCV) infection or zinc deficiency. It is characterized by erythematous or violaceous lesions occurring primarily in the lower extremities. The treatment includes systemic steroids and oral zinc supplementation. We report a case of NAE in a 66-year-old human immunodeficiency virus (HIV)/HCV co-infected woman with NAE. NAE is rarely reported in co-infected patients and the exact mechanisms of pathogenesis are still unclear.

CASE SUMMARY

A 66-year-old HIV/HCV co-infected female patient presented with painless, non-pruritic rash of extremities for one week and underwent extensive work-up for possible rheumatologic disorders including vasculitis and cryoglobulinemia. Punch skin biopsies of right and left thigh revealed thickened parakeratotic stratum corneum most consistent with NAE. Patient was started on prednisone and zinc supplementation with resolution of the lesions and improvement of rash.

CONCLUSION

Clinicians should maintain high clinical suspicion for early recognition of NAE in patients with rash and HCV.

Keywords: Necrolytic acral erythema; Human immunodeficiency virus; Hepatitis C virus; Zinc deficiency; Case report

Core tip: Necrolytic acral erythema (NAE) is a rare dermatological entity associated with hepatitis C virus (HCV) and zinc deficiency. Aim of the case report is to describe the occurrence of NAE in a human immunodeficiency virus/HCV coinfected patient, elucidate the clinical characteristics, pathophysiologic mechanisms and increase clinician awareness about diagnosis and management.