Nummular Eczema as the Initial Extrahepatic Manifestation of Hepatitis C Virus Infection: A Case Report

Abstract

Although dermatological manifestations are common in hepatitis C virus (HCV) infection, nummular eczema is rarely reported in this context. We describe the case of a 73-year-old man with a seven-month history of pruritic lesions on the posterior thorax, unresponsive to symptomatic treatment. Physical and dermoscopic examination revealed well-demarcated, coin-shaped plaques with peripheral erythema and fine desquamation. Histopathology confirmed chronic inflammatory dermatitis. Laboratory tests showed elevated transaminases and high HCV viral load. The patient had a history of blood transfusion two decades prior but no prior HCV diagnosis. He was treated with a 12-week course of glecaprevir/pibrentasvir, which resulted in complete resolution of skin lesions and normalization of liver enzymes within one month. No adverse events were recorded. This case highlights the importance of recognizing atypical dermatological signs as possible early indicators of HCV infection and supports the effectiveness of direct-acting antivirals in resolving both hepatic and extrahepatic manifestations.

Keywords: extrahepatic manifestations; glecaprevir; hepatitis c; nummular dermatitis; pibrentasvir.

Figure 1. Clinical image of a solitary, well-demarcated, oval lesion (1.5-2 cm) on the posterior thoracic region, showing peripheral erythema, fine scaling, and a central pink, dry area consistent with nummular eczema.

Figure 2. Dermatoscopic image showing a pinkish-erythematous background with irregular superficial desquamation and central dry scaling, compatible with chronic inflammatory dermatosis suggestive of nummular eczema.

Figure 3. Skin biopsy showing epidermal perinuclear vacuolization, interface dermatitis, and chronic inflammatory infiltrate in perivascular and periappendageal regions.