Necrotizing cutaneous lesions complicating treatment with pegylated-interferon alfa in an HIV-infected patient

European Journal of Dermatology. Volume 12, Number 1, 99-102, January - February 2002, Cas cliniques

Author(s) : Didier BESSIS, Audrey CHARRON, Régine ROUZIER-PANIS, Véronique BLATIERE, Jean-Jacques GUILHOU, Jacques REYNES, Service de Dermatologie-Phlébologie, CHU Montpellier, Hôpital Saint-Éloi, 80, avenue Augustin-Fliche, 34295 Montpellier Cedex 5, France..

Summary : Pegylated interferon alfa is a pegylated formulation of recombinant human interferon (IFN) conjugated with polyethylene-glycol (PEG). The major advantages of this formulation, compared to standard IFN, is a prolonged half-life which allows for once-weekly injection. Its antiviral efficacy in association with ribavirin as a new standard treatment of chronic hepatitis C has been recently documented. Efficacy of PEG-IFN in the therapy of HIV infection is currently being evaluated in prospective pilot studies. We describe herein the first observation of cutaneous necrosis at the sites of PEG-IFN injection in an HIV-infected patient. A 50-year-old man, HIV infected, was treated with antiretroviral bitherapy combining zidovudine and didanosine for 30 months. Weekly subcutaneous injections of PEG-IFN-alpha-2b were started at a dose of 1.5 mug/kg. Nine months later, two successive necrotizing cutaneous lesions developed at the site of injection. The cutaneous ulcerations slowly healed under local therapy without interruption or dose modification of the PEG-IFN. We review the literature on previously reported cases of cutaneous necrosis following standard or pegylated IFN-alpha injection and discuss the different pathophysiological mechanisms that might be involved.

Keywords : pegylated interferon, cutaneous necrosis.

Pictures


		Figure 1. *(A)* Necrotic cutaneous lesions of the abdominal wall at the sites of PEG-IFN injection. Note the symmetrical localization on each side of the navel. (B) Close-up view of one of the necrotic lesions: inflammatory infiltrated plaque with a central dry escarotic scab.


		Figure 2. *(A)* Histological section of a lesion biopsy: inflammatory septal lesion with lymphocytic and neutrophilic infiltrate of the hypodermis (haematoxylin-eosin; original magnification x 25). (B) Close-up view on lymphocytic and neutrophilic wall-infiltration of venule of the hypodermis (HE x 40).