# Nummular Eczema as the Initial Extrahepatic Manifestation of Hepatitis C Virus Infection: A Case Report

## TL;DR

A man's skin condition called nummular eczema was the first sign of hepatitis C virus infection, which was successfully treated with antiviral drugs.

## Contribution

This case report highlights nummular eczema as a rare early sign of HCV infection and demonstrates the effectiveness of direct-acting antivirals.

## Key findings

- Nummular eczema can be an initial extrahepatic manifestation of HCV infection.
- Treatment with glecaprevir/pibrentasvir resolved both skin lesions and liver enzyme abnormalities.
- The patient had no prior HCV diagnosis despite a history of blood transfusion.

## Abstract

Although dermatological manifestations are common in hepatitis C virus (HCV) infection, nummular eczema is rarely reported in this context. We describe the case of a 73-year-old man with a seven-month history of pruritic lesions on the posterior thorax, unresponsive to symptomatic treatment. Physical and dermoscopic examination revealed well-demarcated, coin-shaped plaques with peripheral erythema and fine desquamation. Histopathology confirmed chronic inflammatory dermatitis. Laboratory tests showed elevated transaminases and high HCV viral load. The patient had a history of blood transfusion two decades prior but no prior HCV diagnosis. He was treated with a 12-week course of glecaprevir/pibrentasvir, which resulted in complete resolution of skin lesions and normalization of liver enzymes within one month. No adverse events were recorded. This case highlights the importance of recognizing atypical dermatological signs as possible early indicators of HCV infection and supports the effectiveness of direct-acting antivirals in resolving both hepatic and extrahepatic manifestations.