RESUMO
Tenofovir, a nucleotide analog, is one of the first-line medications recommended for the treatment of active chronic hepatitis B virus infection [CHB] and as a primary prophylaxis to prevent hepatitis B reactivation in cases of immunosuppression. We report the first case of tenofovir-induced leukocytoclastic vasculitis [LCV]. A 43-year-old obese woman, who was known to have inactive CHB, was diagnosed with chronic immune thrombocytopenic purpura [ITP]. She was treated with corticosteroid therapy and was put on tenofovir to prevent hepatitis B virus reactivation. A month later, she developed a skin rash, described as non-blanchable well-defined erythematous to violaceous papules and targetoid patches in her lower extremities. A skin biopsy showed features of LCV. The rash resolved completely within few days after replacing tenofovir with entecavir
RESUMO
Auto-immune hepatitis [AIH] is a chronic progressive hepatitis of unknown aetiology whose clinical presentation ranges from asymptomatic to fulminant hepatic failure. Corticosteroids and azathioprine, which are considered standard therapy for AIH, may, however, be associated with treatment failures and toxicities. Among the alternative medications under investigation, rituximab, used to treat successfully various auto-immune disorders, has fewer side effects. We report herein the case of a 68-year-old woman who developed AIH with worsening clinical, laboratory and histological features despite high-dose prednisone. On rituximab, the patient showed rapid and dramatic clinical improvement, suggesting a therapeutic role for this medication in severe AIH. Indeed, prospective controlled studies are needed to assess and validate this role