Katsuta Michie, Asahina Akihiko, Shiohara Tetsuo
Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan.
Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan.
Case Rep Dermatol. 2020 Feb 4;12(1):25-32. doi: 10.1159/000505477. eCollection 2020 Jan-Apr.
Although hepatitis C virus (HCV) infection is often associated with extrahepatic cutaneous manifestations such as lichen planus, it is unclear whether HCV or HCV-specific immune responses play a pathophysiological role in the development of HCV-related cutaneous diseases. We recently treated a patient who developed parapsoriasis en plaque-like lesions after ingestion of various drugs. She showed hypersensitivity to multiple drugs after interferon therapy. Her clinical course was complicated by flares of parapsoriasis-like lesions which returned at precisely the same sites. The flares had begun within hours of ingesting nicardipine hydrochloride, amlodipine besilate, candesartan cilexetil and atenolol for the first time despite showing a low level of HCV RNA. Interestingly, the flares gradually subsided during continued treatment with these drugs while her HCV RNA level paradoxically increased: thus, there was an inverse correlation between flares and HCV RNA level. The eruptions were eventually diagnosed as fixed drug eruption, although the clinical manifestations mimicked parapsoriasis en plaque. Our results suggest that multiple drug hypersensitivity could be induced by antiviral immune responses that are cross-reactive to multiple drugs, but not by HCV .
虽然丙型肝炎病毒（HCV）感染常与扁平苔藓等肝外皮肤表现相关，但尚不清楚HCV或HCV特异性免疫反应在HCV相关皮肤病的发生发展中是否起病理生理作用。我们最近治疗了一名在摄入多种药物后出现点滴状副银屑病样皮疹的患者。她在干扰素治疗后对多种药物表现出超敏反应。她的临床病程因副银屑病样皮疹的发作而复杂化，这些皮疹会在完全相同的部位复发。尽管HCV RNA水平较低，但在首次服用盐酸尼卡地平、苯磺酸氨氯地平、坎地沙坦酯和阿替洛尔后的数小时内就开始出现皮疹发作。有趣的是，在继续使用这些药物治疗期间，皮疹逐渐消退，而她的HCV RNA水平却反常地升高：因此，皮疹发作与HCV RNA水平呈负相关。尽管临床表现类似点滴状副银屑病，但最终这些皮疹被诊断为固定性药疹。我们的结果表明，多种药物超敏反应可能是由对多种药物产生交叉反应的抗病毒免疫反应引起的，而非由HCV引起。
