Since then, 20 cases of patients with pigmentation of oral mucosa associated with interferon alfa and ribavirin therapy have been reported, including the present case (13 women and 7 men in total).
Hyperpigmentation of oral mucosa associated with interferon alfa and ribavirin combination therapy for hepatitis C was first described by Willems et al. Withdrawal of treatment was not required and the lesions have remained stable until present, despite continuing with treatment. The patient did not have any hyperpigmented cutaneous lesions, and no systemic symptoms were apparent at the time. 2) and similar lesions were detected on the vulvar mucosa. Pigmentation was also observed on both cheek mucosae ( Fig. In the examination, pigmented grey-blue macules were seen located mainly on the lateral areas of the dorsum of the tongue ( Fig. In April 2011, 1 month after the start of the second course of pegylated interferon alfa and ribavirin, the patient presented with a burning sensation on the tongue and noted pigmentation of the oral and genital mucosa. In July 2011, she received treatment with rituximab (2 doses) with resolution of the leukocytoclastic vasculitis. From April 2011, she underwent 5 sessions of plasmapheresis and treatment with pegylated interferon alfa (180 μg/week) and ribavirin (1000 mg/d) was restarted. In June 2010, the patient presented with leukocytoclastic vasculitis and arthralgia associated with cryoglobulinemia, and received treatment with colchicine and pulses of oral prednisone. In May 2008, she started treatment with pegylated interferon alfa and ribavirin with suboptimal therapeutic adherence until November 2009. The patient was 49 years old and had a history of allergy to acetylsalicylic acid, depressive disorder, and chronic hepatitis C genotype 1 infection, diagnosed in 2007. We report a new case of oral pigmentation associated with this therapy in a white woman who also developed genital mucosal lesions. Since 2003, there have been reports of oral hyperpigmentation associated with interferon alfa and ribavirin therapy for hepatitis C.
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