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The Annals of Pharmacotherapy: Vol. 38, No. 1, pp. 173-174. DOI 10.1345/aph.1D198
© 2004 Harvey Whitney Books Company.
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Cutaneous ulceration induced by interferon alfa

Luca Gallelli, MD PhD

Assistant Chair of Pharmacology Department of Experimental and Clinical Medicine Faculty of Medicine and Surgery University Magna Graecia of Catanzaro Regional Pharmacovigilance Center Mater Domini University Hospital Via T. Campanella 115 88100 Catanzaro, Italy fax 39-0-961-774424 luca_gallelli{at}hotmail.com

Vincenzo Guadagnino, MD

Full Professor Chair of Infectious Diseases Department of Experimental and Clinical Medicine Faculty of Medicine and Surgery University of Catanzaro

Benedetto Caroleo, MD

Clinical Specialist Chair of Infectious Diseases Department of Experimental and Clinical Medicine Faculty of Medicine and Surgery University of Catanzaro

Norma Marigliano, MD

Assistant Chair of Pharmacology Department of Experimental and Clinical Medicine Faculty of Medicine and Surgery University Magna Graecia of Catanzaro Regional Pharmacovigilance Center Mater Domini University Hospital

Giovambattista De Sarro, MD

Full Professor Chair of Pharmacology Department of Experimental and Clinical Medicine Faculty of Medicine and Surgery University Magna Graecia of Catanzaro Regional Pharmacovigilance Center Mater Domini University Hospital

Published Online, December 5, 2003. www.theannals.com, DOI 10.1345/aph.1D198

TO THE EDITOR: Subcutaneous interferon (INF) injections are able to induce cutaneous local necrosis via a procoagulant mechanism or local allergic reaction.1 These skin manifestations have been shown to resolve following a change of injection site and topical treatment.2-4 We describe the case of a man who presented with cutaneous ulcerations during INF treatment.

Case Report. A 56-year-old man with chronic hepatitis C infection presented with cutaneous ulcerations and a high antinuclear antibody (ANA) titer 7 months after initiation of pegylated INF-alfa treatment. Change of injection site and topical treatment did not stop these skin lesions. Therefore, 3 months later, pegylated INF-alfa therapy was discontinued due to a relevant increase in ANA titer (Table 1) and a progression of cutaneous lesions.


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  		Table 1. Hematologic and Blood Chemical Findings During Pegylated Interferon-Alfa Therapy

 

Tests for other autoimmune serologic manifestations (antimicrosomal antibody, anti–smooth-muscle antibodies, liver–kidney microsomal antibodies, thyroid peroxidase antibodies, antidouble-stranded DNA) and for total and differential circulating immunoglobulins (Igs) were negative. Histologic examination of skin lesions revealed perivascular infiltration of lymphoid cells of the upper derma without an increase of Ig blood values, suggesting a nonallergic mechanism for these manifestations.

Two months after pegylated INF-alfa therapy interruption, a new evaluation showed a significant decrease in transaminase values (Table 1) and a partial remission of cutaneous ulcers. During follow-up performed 12 months later, we recorded a complete remission of skin manifestations and a complete reduction in ANA titer (Table 1). Use of the Naranjo probability scale indicated a probable relationship between the bilateral skin eruption and pegylated INF therapy in our patient.5

We conclude that an INF-associated immunologic mechanism is involved in skin ulcer manifestations that could be relevant in the future setting of therapy.

References

  1. Christian MM, Diven DG, Sanchez RL, Soloway RD. Injection site vasculitis in a patient receiving interferon alfa for chronic hepatitis C.J Am Acad Dermatol 1997;37:118-20.[Medline]
  2. Kurzen H, Petzoldt D, Hartschuh W, Jappe U. Cutaneous necrosis after subcutaneous injection of polyethylene-glycol-modified interferon alpha.Acta Derm Venereol 2002;82:310-2.[Medline]
  3. Pouthier D, Theissen F, Humbel RL. Lupus syndrome, hypothyroidism and bullous skin lesions after interferon alfa therapy for hepatitis C in a haemodialysis patient. Nephrol Dial Transplant 2002;17:174.[Free Full Text]
  4. Bessis D, Charron A, Rouzier-Panis R, Blatiere V, Guilhou JJ, Reynes J. Necrotizing cutaneous lesions complicating treatment with pegylated-interferon alfa in an HIV-infected patient. Eur J Dermatol 2002;12:99-102.[Medline]
  5. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions.Clin Pharmacol Ther 1981;30:239-45.[Medline]



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L. Gallelli, M. Ferraro, G. F Mauro, and G. De Sarro
Generalized exfoliative dermatitis induced by interferon alfa
Ann. Pharmacother., December 1, 2004; 38(12): 2173 - 2174.
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