Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 27, 2019; 11(4): 402-408
Published online Apr 27, 2019. doi: 10.4254/wjh.v11.i4.402
Leukocytoclastic vasculitis caused by hepatitis C virus in a liver transplant recipient: A case report
Gustavo de Sousa Arantes Ferreira, Andre Luis Conde Watanabe, Natalia de Carvalho Trevizoli, Fernando Marcus Felippe Jorge, Luiz Gustavo Guedes Diaz, Milla Carolina Costa Lafeta Araujo, Gabriela de Campos Araujo, Amanda de Castro Machado
Gustavo de Sousa Arantes Ferreira, Andre Luis Conde Watanabe, Natalia de Carvalho Trevizoli, Fernando Marcus Felippe Jorge, Luiz Gustavo Guedes Diaz, Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal, Brasilia 70673-900, Brazil
Milla Carolina Costa Lafeta Araujo, Gabriela de Campos Araujo, Amanda de Castro Machado, Curso de Medicina, Universidade Catolica de Brasilia, Brasilia 71966-700, Brazil
Author contributions: Trevizoli NC and Watanabe ALC designed the report; Ferreira GSA and Araujo MCCL collected the patient’s clinical data; Ferreira GSA, Araujo GC and Machado AC analyzed the data and wrote the paper; Jorge FMF and Diaz LGG reviewed the paper.
Informed consent statement: Consent was obtained from the patient.
Conflict-of-interest statement: The authors declare no conflicts of interest.
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: Gustavo de Sousa Arantes Ferreira, MD, Surgeon, Department of Liver Transplantation, Instituto de Cardiologia do Distrito Federal, Setor Sudoeste, S/Nº, Brasilia 70673-900, Brazil. arantesferreira@yahoo.com.br
Telephone: +55-61-34035485 Fax: +55-61-34035400
Received: January 18, 2019
Peer-review started: January 18, 2019
First decision: March 5, 2019
Revised: March 16, 2019
Accepted: April 8, 2019
Article in press: April 8, 2019
Published online: April 27, 2019
Processing time: 98 Days and 2.2 Hours
Abstract
BACKGROUND

Infection by the hepatitis C virus (HCV) is currently considered to be a global health issue, with a high worldwide prevalence and causing chronic disease in afflicted individuals. The disease largely involves the liver but it can affect other organs, including the skin. While leukocytoclastic vasculitis has been reported as one of the dermatologic manifestations of HCV infection, there are no reports of this condition as the first symptom of HCV recurrence after liver transplantation.

CASE SUMMARY

We report here a case of leukocytoclastic vasculitis in a liver transplant recipient on maintenance immunosuppression. The condition presented as a palpable purpura in both lower extremities. Blood and urine cultures were negative and all biochemical tests were normal, excepting evidence of anemia and hypocomplementemia. Imaging examination by computed tomography showed a small volume of ascites, diffuse thickening of bowel walls, and a small bilateral pleural effusion. Skin biopsy showed leukocytoclasia and fibrinoid necrosis. Liver biopsy was suggestive of HCV recurrence in the graft, and HCV polymerase chain reaction yielded 11460 copies/mL and identified the genotype as 1A. Treatment of the virus with a 12-wk direct-acting antiviral regimen of ribavirin, sofosbuvir and daclatasvir led to regression of the symptoms within the first 10 d and subsequent complete resolution of the symptoms.

CONCLUSION

This case highlights the difficulties of diagnosing skin lesions caused by HCV infection in immunosuppressed patients.

Keywords: Hepatitis C; Liver transplantation; Leukocytoclastic vasculitis; Immunosuppression; Direct-acting antivirals; Case report

Core tip: Leukocytoclastic vasculitis is an uncommon extrahepatic manifestation of infection by the hepatitis C virus (HCV). We report the case of a patient who underwent liver transplantation for the treatment of cirrhosis and hepatocellular carcinoma associated with HCV infection, and who developed skin lesions and systemic symptoms, such as fever, post-transplantation. A short time after HCV antiviral treatment was started, the patient showed complete regression of all symptoms. While there are previous reports of leukocytoclastic vasculitis in solid organ transplant recipients, we have found no previous case in the literature of this being a symptom of HCV recurrence in this context.