Abstract

Background: The development of direct-acting antivirals directed against the Hepatitis C Virus has dramatically modified the therapeutic approach to chronic hepatic viral disease. Larger use of such drugs has also led to increasing reports about their adverse effects. This report aimed to describe a case of leucocytoclasic vasculitis following treatment based on the sofosbuvir/ledipasvir regimen with complete disappearance shortly after withdrawal in a 61-year-old patient treated for genotype 1 hepatitis C.

Case Presentation: A 61-year-old Tunisian woman with a history of hepatitis C virus genotype 1 infection developed palpable purpura in front of low extremity articulation, five weeks after the onset of sofosbuvir/Ledipasvir. The histological examination concluded with leucocytoclasic vasculitis, with total disappearance three days after withdrawal. The pre-therapeutic assessment showed no positivity of Cryoglobulinemia. Anti-neutrophil cytoplasmic antibodies (ANCA) were negative. A sustained viral response was obtained only 5 weeks after treatment without an increase of viral load during follow-up.

Conclusion: There was a temporal relationship between antiviral treatment and non-ANCA skin vasculitis. The pharmacological department concluded the imputability of antiviral treatment (score I2B2).

Keywords: Leucocytoclasic vasculitis, direct-acting antivirals, hepatitis C, drug adverse effect, sofosbuvir/ledipasvir, ANCA.

Graphical Abstract