Repeated episodes of fixed eruption 3 months after discontinuing pegylated interferon-α-2b plus ribavirin combination therapy in a patient with chronic hepatitis C virus infection

Abstract

We report a 73-year-old man who developed repeated episodes of erythematous, bullous plaques beginning 3 months after discontinuation of combination treatment with pegylated interferon (IFN)-α-2b and ribavirin for hepatitis C virus infection. The first episode resolved within a week without treatment, but the lesions recurred about once a month and were associated with high fever. Physical examination found darkly reddish, pigeon-egg-sized erythematous plaques with occasional flaccid blisters, predominantly on the trunk and proximal limbs, lip and penis. Histological examination showed well-demarcated foci of full-thickness epidermal necrosis and exocytosis of lymphoid cells. Pegylated IFN-α2b and ribavirin produced no response in lymphocyte stimulation tests. Systemic prednisolone led to rapid healing of skin lesions at the time of the fifth episode, leaving pigmented macules, but lesions recurred at the same sites within weeks of discontinuation of this treatment. It is uncertain whether this case represented a prolonged drug rash provoked by pegylated IFN-α2b or a fixed eruption in response to another antigen. © 2008 British Association of Dermatologists.