Antiviral Therapy for Hepatitis C Leads to Porphyria Cutanea Tarda Remission, Case Study Shows

The antiviral combo therapy of ribavirin and sofosbuvir successfully cleared a patient’s hepatitis C virus and led to remission of his porphyria cutanea tarda (PCT), a case study reports.

The study, “Improvement of porphyria cutanea tarda following treatment of hepatitis C virus by direct-acting antivirals: A case report,” was published as a letter in The Journal of Dermatology.

PCT, the most common subtype of porphyria, can result from low levels of the uroporphyrinogen decarboxylase (UROD) enzyme. UROD is crucial to produce heme, a molecule that is part of several important proteins such as hemoglobin, the carrier of oxygen in the blood.

PCT can be caused by genetic factors — mutations in the gene responsible for the UROD enzyme — or by non-genetic factors such as alcohol abuse, excess of iron in the liver, or hepatitis C virus (HCV) infection.

HCV, a liver infection, is now treated with antiviral therapies that significantly improve patients’ prognosis.

In the case report, researchers looked at an HCV patient who, after being treated with direct-acting antivirals (DAA), saw significant improvement of his PCT. DAAs are medications, such as ribavirin (sold as Ribasphere, among others) and sofosbuvir (sold as Sovaldi), that target specific stages of the HCV life cycle.

The patient, a 68-year-old Japanese man, infected with HCV for 11 years, had blisters on sun-exposed skin. He also had nail deformities previously diagnosed as lichen planus — a skin rash triggered by an immune response.

When the researchers first saw him, he had been treated with ribavirin/sofosbuvir (RBV-SOF) antiviral therapy for two months and had blisters, erosions, and scars on his dorsal forearms and hands, along with the nail deformities.

A biopsy of a tense blister in the skin showed extensive inflammation. Urine analysis revealed abnormally high levels of uroporphyrin, giving the urine a pink tone, which was detected using an ultraviolet lamp.

The patient was diagnosed with PCT, as porphyrins are precursors of heme and their accumulation is a hallmark of the disease.

With continuation of RBV-SOF, the levels of liver damage key markers — the enzymes, alanine aminotransferase and alkaline phosphatase — normalized, and the HCV viral load also cleared. The levels of urinary uroporphyrin were reduced as well.

After completing a year of the therapy, the patient’s skin eruptions had disappeared. However, the nail deformities were still present.

The authors concluded that further studies are needed to investigate the antiviral medications’ capacity to alleviate PCT symptoms. They added that the effectiveness of the RBV-SOF combination may be due to one of the therapies.

“Because [ribavirin] may aggravate PCT by contributing to iron overload in the liver, it is likely that [sofosbuvir], a DAA, was responsible for the remission of PCT in our case,” they said.