Liver Unit, Ereditarie-Istituto San Gallicano, IRCCS, Rome, Italy.
Ann Hepatol. 2012 Nov-Dec;11(6):951-4.
Porphyria cutanea tarda (PCT) is the most common type of porphyria. The strong association between PCT and hepatitis C virus (HCV) infection is well established. Although antiviral treatment of chronic hepatitis C may improve PCT in some cases, de novo onset of PCT has been observed in patients under- going peginterferon/ribavirin treatment. We present a rare case of a genotype 3 HCV-positive liver transplant recipient who developed PCT during antiviral treatment and discuss its probable etiopathogenesis.
A genotype 3 HCV-positive liver transplant recipient, a 42-year-old man, was treated with peginterferon alfa-2a (180 µg/week) combined with ribavirin (1,200 mg/day) for recurrence of HCV infection after liver transplantation. He presented with hyperferritinemia but tested negative for genetic hemochromatosis (C282Y and H63D mutations). During antiviral therapy, he developed skin lesions on his hands characterized by vesicles and erosions consistent with PCT. PCT was confirmed by skin biopsy and elevated urinary uroporphyrin levels (1,469 mg/24 h). He was treated with chloroquine (200 mg) twice weekly, resulting in gradual regression of the skin lesions. Antiviral treatment was stopped after 48 weeks, and the patient achieved a sustained virological response. In conclusion, we report an extremely rare case of PCT in a genotype 3 HCV-positive liver transplant patient treated with antiviral therapy. We believe that the combination of HCV genotype 3 infection; hemolysis due to ribavirin treatment; and increased plasma levels of cytokines, such as IL-6 and TNFα, could have altered the patient's iron metabolism and thus caused PCT.
迟发性皮肤卟啉病（PCT）是最常见的卟啉病类型。PCT 与丙型肝炎病毒（HCV）感染之间的强关联性已得到充分证实。虽然慢性丙型肝炎的抗病毒治疗可能在某些情况下改善 PCT，但在接受聚乙二醇干扰素/利巴韦林治疗的患者中已观察到新发性 PCT。我们报告了一例罕见的基因型 3 HCV 阳性肝移植受者在抗病毒治疗期间发生 PCT 的病例，并讨论了其可能的发病机制。
一名基因型 3 HCV 阳性肝移植受者，一名 42 岁男性，因肝移植后 HCV 感染复发接受聚乙二醇干扰素 alfa-2a（180 µg/周）联合利巴韦林（1,200 mg/天）治疗。他表现为高血铁蛋白血症，但基因遗传性血色病（C282Y 和 H63D 突变）检测阴性。在抗病毒治疗期间，他出现手部皮肤病变，表现为水疱和糜烂，符合 PCT 的特征。通过皮肤活检和升高的尿卟啉水平（1,469 mg/24 h）证实了 PCT。他接受了氯喹（200 mg）每周两次治疗，皮肤病变逐渐消退。抗病毒治疗在 48 周后停止，患者获得持续病毒学应答。总之，我们报告了一例极其罕见的基因型 3 HCV 阳性肝移植患者在抗病毒治疗期间发生 PCT 的病例。我们认为，HCV 基因型 3 感染、利巴韦林治疗引起的溶血以及细胞因子（如 IL-6 和 TNFα）水平升高，可能改变了患者的铁代谢，从而导致 PCT。
