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Case Reports
. 2019 Feb 27;11(2):226-233.
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  1 , Dost Sarpel  2 , Alexandra Abrams-Downey  2 , Adnan Mubasher  3 , Douglas T Dieterich  4
Affiliations
Case Reports

Necrolytic acral erythema in a human immunodeficiency virus/hepatitis C virus coinfected patient: A case report

Katerina G Oikonomou et al. World J Hepatol. .

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

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Typical appearance of necrolytic acral erythema involving the right upper and right and left lower extremities.
Figure 2
Figure 2
Low and high power of skin histopathology demonstrating bullous/hemorrhagic cellulitis with thick parakeratosis, impetiginization of the dermis and rare scattered neutrophilic infiltrates with dermal hemorrhage.
See this image and copyright information in PMC

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