Photo-induced drug eruption in a patient on combination simeprevir/sofosbuvir for hepatitis C

Fig 1. Photo-distributed eruption in a patient on simeprevir. The patient presented with a large erosion of the lower vermilion with honey-colored and hemorrhagic crusting (A) and ill-defined erythematous plaques with overlying tense bullae on the dorsolateral hands (B). INTRODUCTION Recently there has been a rapid evolution in the treatment of hepatitis C heralded by development of the direct-acting antiviral agents, which target specific aspects of the hepatitis C virus viral cycle. These agents have shown improved sustained virologic response rates compared with traditional therapy with combined pegylated interferon and ribavirin. Simeprevir, a direct-acting antiviral agent, is a second-generation viral protease inhibitor that has proven highly effective and safe for the treatment of genotype I chronic hepatitis C and was approved by the US Food and Drug Administration in November 2013. In clinical trials, simeprevir was initially used in combination with ribavirin and pegylated interferon alfa but recently has been paired with another newly emerged targeted antiviral, sofosbuvir. Sofosbuvir is a nucleotide analog inhibitor of hepatitis C viral polymerase. In a recent randomized trial that compared patients on combined simeprevir/sofosbuvir with or without ribavirin, a rash was seen in 13.6% of the patients on the combined therapy without ribavirin. To date, there are few clear descriptions of this rash in the medical literature. We present a case of a photo-induced drug eruption in a patient on simeprevir and sofosbuvir for hepatitis C.