A 63- year- old woman presented with anemia (Hb= 7.9) and skin lesions most probably urticarial vasculitis. The patient gave a history of hepatitis C virus and was treated with direct-acting antivirals in the form of Daclatasvir and sofosbuvir for 12 weeks with a sustained virological response on follow-up periods. Three months after completion of antiviral therapy the patient began to complain of easy fatigability and skin lesions. Laboratory investigations revealed iron deficiency anemia that needed packed RBCs transfusion. Also, there was a mild, indirect hyperbilirubinemia. Direct Coomb test was negative. Bone marrow aspiration was reasonable. Abdominal ultrasonography revealed moderate splenomegaly and coarse liver. Upper GI endoscopy showed patchy gastric inflammation in the fundus and pyloric region. Also, there were patches of inflammation in the duodenum. The question is gastritis and duodenitis the cause of this patient anemia, or there are other reasons for the patient symptoms. In my opinion, it is not the only cause of the patient's anemia. So I recommend the patient for lower GI endoscopy. Also, I give the patient carvedilol( for gastropathy) and proton pump inhibitor. Dermovate was prescribed for skin lesions.
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