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Volume 63, Issue 2 , Pages 259-265, August 2010

Leukocytoclastic vasculitis and necrolytic acral erythema in patients with hepatitis C infection: Do viral load and viral genotype play a role?

Mohammad A. El-Darouti, MD
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Reprint requests: Mohammad A. El-Darouti, MD, 47 Al Falaki Street, Bab El Louk, Cairo 11471, Egypt.
Heba M. Mashaly, MD
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
Eman El-Nabarawy, MD
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
Amal M. Eissa, MD
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
Mona R.E. Abdel-Halim, MD
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
Marwa M.T. Fawzi, MD
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
Nermine H. El-Eishi, MD
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
Sherine O. Tawfik, MD
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
Naglaa S. Zaki, MD
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
Anoud Z. Zidan, MD
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
Marwa Fawzi, MD
- Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
Mohammad Abdelaziz, MD
- Al Houd Al Marsoud Dermatology Hospital, Cairo, Egypt
Mai M.T. Fawzi, MD
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
Olfat G. Shaker, MD
- Department of Medical Biochemistry, Faculty of Medicine, Cairo University, Cairo, Egypt

Accepted 8 July 2009. published online 12 May 2010.

Background

Leukocytoclastic vasculitis (LCV) and necrolytic acral erythema (NAE) are skin disorders associated with hepatitis C virus (HCV) infection. However, they have not been found to occur simultaneously in the same patient.

Objective

We sought to analyze the role of serum HCV-RNA levels and HCV genotype in the pathogenesis of both LCV and NAE in an attempt to assess whether these two parameters play a role in mutual exclusivity of LCV and NAE in the same patient.

Methods

The study included 11 patients with LCV and 13 with NAE, all of whom were infected with HCV. All 24 patients were evaluated for the quantitative levels of HCV-RNA, using real-time polymerase chain reaction. HCV genotyping was performed on 10 patients in each group (N = 20).

Results

Patients with LCV had a higher prevalence of moderate and high levels of HCV-RNA viremia (P = .038) than those with NAE. However, there was no significant difference in HCV genotype between LCV and NAE groups (P = .211).

Limitations

Small number of cases is a limitation.

Conclusion

Viral load seems to play a role in determining the response of the skin to HCV infection. High levels of HCV viremia were found to be significantly associated with LCV but not with NAE. HCV viremia may play a role in the development of LCV in HCV-infected patients.

Key words: Hepatitis C, hepatitis C viral load, hepatitis C virus genotype, hepatitis C virus–RNA quantitative polymerase chain reaction, leukocytoclastic vasculitis, necrolytic acral erythema

Abbreviations used: HCV, hepatitis C virus, LCV, leukocytoclastic vasculitis, NAE, necrolytic acral erythema, PCR, polymerase chain reaction, UTR, untranslated region