Hyperpigmentation of tongue associated with hepatitis C treatment.

A 55-year-old white woman receiving peginterferon alfa2a (180 mg) and ribavirin (1200 mg) combination therapy for hepatitis C virus (HCV; genotype 1b) infection complained of a burning sensation and discomfort in her tongue in the second month, and tongue hyperpigmentation in the fourth month of the therapy. Physical examination revealed hyperpigmentation on the lateral and dorsal parts of the tongue (Figure 1). There was no hyperpigmentation on any other part of her body. Tongue biopsy was performed to exclude other causes, which revealed minimal parakeratosis, irregular acanthosis, melanin pigment and macrophage accumulation of subepithelial connective tissue, and also focal chronic inflammation (Figure 2). No other reason was detected for hyperpigmentation. At the beginning of the therapy, HCV RNA level was 5.54 × 105 IU/ mL. Therapy was continued for 48 weeks. She was negative for HCV RNA in the first month after the therapy, but positive in the third and sixth months after the therapy. Despite active HCV infection, the tongue hyperpigmentation resolved completely after the end of the therapy.