Lichen myxedematosus associated with chronic hepatitis C

A 55-year-old woman presented with a 4-month history of sclerotic and thick ened lichen myxedematosus (LM) cutaneous lesions on her face and trunk. She suffered from chronic hepatitis and had been seen by a physician for 8 mon ths. Examination revealed an asymptomatic hard nodular lesion on her nose, multiple flesh-colored papules grouped on her nape, upper back, and chest, and painful swollen lesions on both of her hands (Fig. 1). Laboratory data indicated no abnormalities in peripheral blood count, serum gamma-globulin level, serum electrophoresis, immunoelectrophoresis, cryoglobulin, and rheu matoid factor. Triiodothyronine (T3), thyroxine (T4), and thyroid-stimulati ng hormone (TSH) levels were normal; the anti-TSH receptor antibody test wa s negative with a slightly positive anti-TSH antibody. An antinuclear antib ody was detected (x160; homogeneous). Serum immunoglobulin G (IgG) and IgM were elevated (2600 and 281 mg/dL, respectively), but IgA was within the no rmal range. Serum glutamate oxalacetate transaminase (GOT) and glutamate py ruvate transaminase (GPT) levels were elevated (231 and 219 IU/L, respectiv ely). Both anti-hepatitis C virus (anti-HCV) antibodies [fluoro enzyme immu noassay (FEIA); 90.0 cut-off index (COI)] and HCV RNA (reverse transcriptas e polymerase chain reaction) tests were positive (genotype IV2b), while the anti-hepatitis B antibody and hepatitis B antigen tests were negative. Ser um hyaluronic acid was elevated (150 ng/mL). A biopsy of the cutaneous lesi on revealed prominent edema between collagen fibers in the dermis, with acc umulation of abundant mucinous material, ascertained by specific alcian blu e and toluidine blue stains (Fig. 2). Chronic active hepatitis was identifi ed by liver biopsy. Urinalysis revealed no abnormalities and Bence-Jones pr otein was not detected. A chest X-ray and electrocardiogram were normal. The cutaneous lesions started to resolve after 8 months of therapy with ora l corticosteroid (betamethasone 1.5 mg/day).