A rare and severe cutaneous adverse effect of telaprevir: drug rash with eosinophilia and systemic symptoms

G Ital Dermatol Venereol. 2019 Aug;154(4):488-491. doi: 10.23736/S0392-0488.17.05151-3.

Abstract

Telaprevir is a specific inhibitor of the hepatitis C (HCV) serine protease 3. Cutaneous side effects have been reported with telaprevir. Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare yet severe adverse drug-induced reaction characterized by exfoliative dermatitis and maculopapular rash, lymphadenopathy, fever, eosinophilia, leukocytosis, and myriad internal organ involvement. We report a case of DRESS due to telaprevir. A 64-year-old Caucasian man with chronic hepatitis C developed a progressive diffuse, painful maculopapular exanthema with fever, facial edema, lymphadenopathy at week 11 of chronic hepatitis C therapy with telaprevir, Peg-Interferon alfa-2a, and ribavirin. He had no exposures to any other medications. He presented an eosinophilia (up to 6.29 X 109 cells/L), skin biopsy was consistent with a drug reaction. The HCV treatment was stopped and methylprednisolone 0.75 mg/kg/day was started. Cutaneous and systemic symptoms had a rapid resolution in few days. Telaprevir can activate severe skin reactions that can mimic an infectious disease, therefore early diagnosis and discontinuation of chronic hepatitis C treatment is mandatory.

Publication types

  • Case Reports

MeSH terms

  • Antiviral Agents / administration & dosage
  • Antiviral Agents / adverse effects*
  • Drug Hypersensitivity Syndrome / diagnosis
  • Drug Hypersensitivity Syndrome / etiology*
  • Drug Hypersensitivity Syndrome / physiopathology
  • Hepatitis C, Chronic / drug therapy
  • Humans
  • Male
  • Methylprednisolone / administration & dosage
  • Middle Aged
  • Oligopeptides / administration & dosage
  • Oligopeptides / adverse effects*

Substances

  • Antiviral Agents
  • Oligopeptides
  • telaprevir
  • Methylprednisolone