CUTANEOUS LICHEN PLANUS AS A RARE MANIFESTATION OF CHRONIC HEPATITIS B INFECTION: A CASE REPORT

Abstract

Hepatitis B virus (HBV) infection causes severe liver diseases, in-cluding cirrhosis and hepatocellular carcinoma (HCC), and remains a major global health issue, contributing to liver related morbidity and mortality. Autoimmune conditions like Lichen Planus (LP) can exist in patients because of HBV infection. We present a case of a patient with a history of chronic HBV infection, confirmed by HBV DNA positivity via polymerase chain reaction (PCR), who developed clinical symptoms of LP. The patient had been receiving antiviral treatment for chronic HBV. Clinical evidence supports the potential link between LP and HBV infection, although the exact mechanisms remain unclear. Further research involving larger patient populations is essential to fully understand this relationship and to improve screening and management strategies, especially in endemic regions.

Keywords

• Hepatitis B virus
• Lichen planus
• antiviral agents

KRONİK HEPATİT B ENFEKSİYONUNUN NADİR BİR GÖRÜNÜMÜ OLARAK KUTANÖZ LİKEN PLANUS: BİR OLGU SUNUMU

Abstract

Hepatit B virüsü (HBV) enfeksiyonu, siroz ve hepatosellüler karsinom (HCC) dahil olmak üzere ciddi karaciğer hastalıklarına yol açmakta olup, karaciğer kaynaklı morbidite ve mortaliteye katkıda bulunarak halen önemli bir küresel sağlık sorunu olmaya devam etmektedir. Liken Planus (LP) gibi otoimmün hastalıklar, HBV enfeksiyonuna bağlı olarak hastalarda ortaya çıkabilmektedir. Bu yazıda, HBV DNA pozitifliği polimeraz zincir reaksiyonu (PCR) yöntemiyle doğrulanmış kronik HBV enfeksiyonu öyküsü bulunan ve klinik olarak LP semptomları gelişen bir olgu sunulmaktadır. Hastanın kronik HBV enfeksiyonu nedeniyle antiviral tedavi almakta olduğu bilinmektedir. Sonuç olarak, Liken Planus ile HBV enfeksiyonu arasındaki olası ilişki klinik verilerle desteklenmekle birlikte, bu ilişkinin altında yatan mekanizmalar henüz tam olarak aydınlatılamamıştır. Bu ilişkinin kapsamlı şekilde ortaya konulabilmesi ve özellikle endemik bölgelerde tarama ve yönetim stratejilerinin geliştirilmesi amacıyla daha geniş hasta popülasyonlarını içeren ileri araştırmalara ihtiyaç duyulmaktadır.

Keywords

• Hepatit B virüsü
• Lichen planus
• antiviral ajanlar

References

1. Asandem DA, Segbefia SP, Kusi KA, Bonney JHK. Hepatitis B virus infection: A mini review. Viruses 2024;16(5):724. google scholar
2. Nassal, M. HBV cccDNA: viral persistence reservoir and key obstacle for a cure of chronic hepatitis B. Gut 2015;64(12):1972-84. google scholar
3. Mayo Clinic. Lichen planus - Diagnosis and treatment. July 1, 2025 https://www. mayoclinic.org/diseases-conditions/lichen-planus/diagnosis-treatment/drc- 20351383. google scholar
4. Wang JH, Hung SJ. Lichen planus associated with hepatitis B, hepatitis C, and liver cirrhosis in a nationwide cohort study. J Am Acad Dermatol 2021;84(4):1085-6. google scholar
5. Songtanin B, Chaisrimaneepan N, Mendóza R, Nugent K. Burden, Outcome, and comorbidities of extrahepatic manifestations in hepatitis B virus infections. Viruses 2024;16(4):618. google scholar
6. Al-Khenaizan S. Lichen planus occurring after hepatitis B vaccination: A new case. J Am Acad Dermatol 2001;45(4):614-5. google scholar
7. Li H, Yang M, Ma M, Li Z, Li M, Zhu L, et al. Tenofovir for children and adults with chronic hepatitis B. Cochrane Database Syst Rev 2023;2023(9):CD015586. google scholar
8. Huang Q, Zhou B, Cai D, Zong Y, Wu Y, Liu S, et al. Rapid turnover of hepatitis B virus covalently closed circular DNA indicated by monitoring emergence and reversion of signature-mutation in treated chronic hepatitis B patients. Hepatology 2021;73(1):41-52. google scholar

9. Vičić M, Hlača N, Kaštelan M, Brajac I, Sotošek V, Prpić Massari L. Comprehensive insight into lichen planus immunopathogenesis. Int J Mol Sci 2023;24(3):3038. google scholar
10. Shao S, Tsoi LC, Sarkar MK, Xing X, Xue K, Uppala R, et al. IFN-γ enhances cell- mediated cytotoxicity against keratinocytes via JAK2/STAT1 in lichen planus. Sci Transl Med 2019;11(511):eaav7561. google scholar
11. Lodi G, Pellicano R, Carrozzo M. Hepatitis C virus infection and lichen planus: a systematic review with meta-analysis. Oral Dis 2010;16(7):601-12. google scholar
12. Shankar L, Afreen S, Dima Y. Tenofovir-induced lichenoid planus drug reaction. Microbiol Infect Dis 2024;8(4):1-2. google scholar
13. Meredith PA. Generic drugs: therapeutic equivalence. Drug Safety 1996;15(4):233-42. google scholar
14. Kaya S, Arslan E, Baysal B, Baykara SN, Uzun OC, Kaya SL. Lichen planus induced by pegylated interferon alfa-2a therapy in a patient monitored for delta hepatitis. Case Rep Infect Dis 2015;2015:389131. google scholar
15. Sarpel D, Dieterich D. The use of generics to treat chronic hepatitis C: not quite ready for the big stage. Liver Int. 2016;36(7):933-5. google scholar
16. Rayavarapu S, Braithwaite E, Dorsam R, Osterhout J, Furlong LA, Shetty D, et al. Comparative risk assessment of formulation changes in generic drug products: A pharmacology/toxicology perspective, toxicological sciences. 2015;146(1):2-10. google scholar