We describe the case of a male patient who presented with mononeuritis multiplex due to polyarteritis nodosa following recent hepatitis B infection. Despite immunomodulatory treatment, the condition progressed with renal and small bowel involvement and the patient died. This case illustrates the difficulty in treating this multisystem disorder and we review the literature on its pathogenesis and treatment.
JennetteJC, FalkRJ, AndrassyKNomenclature of systemic vasculitides: proposal of an international consensus conference. Arthritis Rheum1994; 37: 187–92.
2.
GockeD, HsuK, MorganC, BombardieriS, LockshinM, ChristianCL.Association between polyarthritis and Australia antigen. Lancet.1970; 2: 1149–1153.
3.
GriffinJ.Vasculitis neuropathies. Rheum Dis Clin North Am.2001; 27: 751–760.
4.
LevineSM, HellmannDB, StoneJH.Gastrointestinal involvement in polyarteritis nodosa (1986- 2000): presentation and outcomes in 24 patients. Am J Med.2002; 112: 386–391.
TrepoC.and Guillevin, L. Polyarteritis Nodosa and extrahepatic manifestations of HBV infection: The case against autoimmune intervention in pathogenesis. J. Autoimmun.2001; 16: 269–274.
7.
ProvenzaleJM, AllenNB.Neuroradiologic findings in polyarteritis nodosa. Am J Neuroradiol1996; 17: 1119–26.
8.
GuillevinL, LhoteF, CohenPPolyarteritis nodosa related to hepatitis B virus: a prospective study with long-term observation of 41 patients. Medicine.1995; 74: 238–253.
9.
CoblynJS, McCLuskeyRT.Case records of the Massachusetts General Hospital: Case 3-2003: A 36-year-old man with renal failure, hypertension, and neurologic abnormalities. NEJM.2003; 348: 333–342.
10.
McMahonB, HeywardW, TemplinDHepatitis B-associated polyarteritis nodosa in Alaskan Eskimos: clinical and epidemiologic features and long-term follow-up. Hepatology.1989; 9: 97–101.
11.
HahneS, RamsayM, BalogunK, EdmundsWJ, MortimerP.Incidence and routes of transmission of hepatitis B virus in England and Wales, 1995-2000: implications for immunisation policy. J Clin Virol.2004; 29 (4): 211–20.
12.
MackenzieAR, MolyneauxPJ, CadwganAM, LaingRB, DouglasJG, SmithCC.Increasing incidence of acute hepatitis B virus infection referrals to the Aberdeen Infection Unit: a matter for concern. Scott Med J.2003; 48 (3): 73–5.
13.
Laboratory reports of Hepatitis B to Scottish Centre for Infection and Environmental Health by NHS Board, Risk Group, and year of report (to 31/12/02)- http://www.show.scot.nhs.uk/SCIEH/.
14.
TsukadaN, KohC, OwaM, YanagisawaN.Chronic neuropathy associated with immune complexes of hepatitis B virus. J Neurol Sci.1983; 61: 193–211.
15.
Wartelle-BladouC., LafonJ., TrepoC.Successful combination therapy of polyarteritis nodosa associated with a pre-core promoter mutant hepatitis B virus infection. J Hepatol.2001; 34 (5): 774–9.
16.
LamKC, LaiCL, TrepoC, WuPC.Deleterious effects of prednisolone in hepatitis B surface antigen-positive chronic active hepatitis. N Engl J Med.1981; 304: 380–386.
17.
GuillevinL, LeT, GayraudM.Systemic vasculitis of the polyarteritis nodosa group and infection with hepatitis B virus: a study in 98 patients. Eur. J. Intern. Med.1989; 1: 97–105.
18.
WoodJR, CzajaAJ, TaswellHF, LudwigJ, RakelaJ, ChaseR.Hepatitis B virus deoxyribonucleic acid in serum during hepatitis Be antigen clearance in corticosteroid-treated severe chronic active hepatitis B. Gastroenterology, 1987; 93: 1225–1230.
19.
GuillevinL, LhoteF, GayraudMPrognostic factors in polyarteritis nodosa and Churg-Strauss syndrome: a prospective study in 342 patients. Medicine.1996; 75: 17–28.
20.
GuillevinL, MahrA, CohenP, LarrocheC, QueyrelV, Loustaud-RattiV, ImbertB, HausfaterP, RoudierJ, BielefeldP, PetitjeanP, SmadjaD; French Vasculitis Study Group. Short-term corticosteroids then lamivudine and plasma exchanges to treat hepatitis B virus-related polyarteritis nodosa. Arthritis Rheum.2004; 51: 482–7.
21.
DeerenDH, De BackerAI, MalbrainML, VerbraekenH, BlockmansD.Treatment of hepatitis B virus-related polyarteritis nodosa: two case reports and a review of the literature. Clin Rheumatol.2004; 23 (2): 172–6.
22.
ZarskiJP, CausseX, CohardM, CougnardJ, TrepoC.A randomised, controlled trial of interferon alfa-2b alone and with simultaneous prednisone for the treatment of chronic hepatitis B. French Multicenter Group. J. Hepatol.1994; 20: 735–741.
23.
KrugerM., BokerKH, ZeidlerH, MannsMP.Treatment of hepatitis B-related polyarteritis nodosa with famciclovir and interferon alfa-2b. J. Hepatol.1997; 26: 935–939.
24.
StecevicV., PevznerMM, GordonSC.J. Successful treatment of hepatitis B associated vasculitis with lamivudine. Clin. Gastroenterol.2003; 36: 451.
25.
BarbaroG, ZechiniF, PellicelliAMLamivudine Italian Study Group Investigators. Long-term efficacy of interferon alpha-2b and lamivudine in combination compared to lamivudine monotherapy in patients with chronic hepatitis B. An Italian multicenter, randomized trial. J Hepatol.2001; 35 (3): 406–11.
26.
WickiJ, OlivieriJ, PizzolatoG, SarasinF, GuillevinL, DayerJMSuccessful treatment of polyarteritis nodosa related to hepatitis B virus with a combination of lamivudine and interferon alpha. Rheumatology1999; 38: 183–5.
27.
BomanS, BallenJL, SeggevJS.Dramatic responses to intravenous immunoglobulin in vasculitis. J Intern Med.1995238(4):375–7.
