Hepatitis Associated Antigen and Periarteritis Nodosa (PAN)

Abstract

The detection of HAA was proved positive in 6 cases out of 7 histologically confirmed PAN.The presence of HAA does not necessarily depend on the evidence of hepatic manifestations. In those 7 cases were indeed observed 2 initial icteric hepatitis biologically and histologically proved, 4 transitory hepatomegalies, and in the last case (which was not the HAA negative one), no hepatic manifestation could be detected. It was possible to prove for at least 4 patients that they did not receive transfusions previously. The detection of HAA was performed by immunodiffusion test only, and our results were controlled in Paris and Lyon. In 2 cases the antigen and the antibody were observed simultaneously.Apparently the antigen appears very precociously and persists for a fairly long time because we can follow its persistency after 30 months in 1 case. To explain these facts, 3 hypothesis can be proposed:1. HAA is not specific of viral hepatitis.2. PAN realizes a highly propicious ground, regarding eventually immunodepressive or corticosteroid therapy, to the development of a subacute anicteric hepatitis with persistant antigenemia as in Down's syndrome.3. Viral hepatitis with HAA seem to represent a disease with antigen-antibody circulating complexes, which could provoke the injuries of PAN.

Hepatotropic Viral Infection Associated Systemic Vasculitides—Hepatitis B Virus Associated Polyarteritis Nodosa and Hepatitis C Virus Associated Cryoglobulinemic Vasculitis

“…Though PAN was first described by Kussmaul and Maier in 1861, but the first description of its association with HBV was given by Tre'po et al and Gocke et al in 1970. [3][4][5] HCV positivity has occasionally been observed in patients with PAN, but it is not considered to be a major etiological factor; and is often observed concomitantly with other viral infections like HBV. [6][7][8] …”

Sex differences in response to hepatitis b virus

“…There are several diseases in which the frequency of HBsAg carriers is higher than in the general population or other diseases. These include chronic hepatitis (14), postnecrotic cirrhosis (15), primary hepatocellular carcinoma (PHC) (1 6), Down's syndrome (1 7), chronic renal disease treated with hemodialysis (18), some forms of leukemia (19), Hodgkin's disease (20), lepromatous leprosy (2 l), polyarteritis nodosa (22), and mixed cryoglobulinemia (23). For some of these, HBV is related to the etiology and/or pathogenesis; for others, abnormalities of the immune system are associated with an increased susceptibility to become a chronic carrier when exposed to the virus.…”

Animal Models of Vasculitis

“…zeek described 5 different categories including 1) hypersensitivity angiitis, 2) allergic granulomatous arteritis as with asthma, 3) rheumatic arteritis involving the small arteries of the heart, 4) the classic periarteritis nodosa of Kussmaul and Maier, and 5) temporal or giant cell arteritis. Hepatitis B vasculitis has been described by several investigators in recent years, accounting for 30-40% ofall cases ofperiarteritis nodosa in some series (52), although others more recently suggested that only 8-10% were due to hepatitis (46). It appears to be the result of deposition ofimmune complex hepatitis B antigen and antibody directly in the tissue.…”

“…Immune complex forms in the presence of excess viral antigen and these deposits in the arterial walls stimulate a lymphocytic response. This condition has been compared to the situation in hepatitis B,-associated arteritis in man (52).…”