Hepatitis B Related Polyarteritis Nodosa Presenting Necrotizing Vasculitis in the Hepatobiliary System Successfully Treated with Lamivudine, Plasmapheresis and Glucocorticoid

Abstract

Abstract

Single-organ gallbladder vasculitis: Characterization and distinction from systemic vasculitis involving the gallbladder. An analysis of 57 patients

“…9,10,12,37,46,54 GB-SOV was found in 20 (33%) patients and GB-SV in 41 (67%). Forms of SV that affected the GB were PAN (n ¼ 10), 4,12,22,32,38,45,46,51,54 HBV-associated vasculitis (n ¼ 8), 10,11,17,38,46,56,60 cryoglobulinemic (essential or HCVassociated) vasculitis (n ¼ 6), 9,14,19,36,50 MPA (n ¼ 4), 5,31,38,40 EGPA (Churg-Strauss) (n ¼ 4), 20,43,48,61 IgA vasculitis (Henoch-Schönlein) (n ¼ 2), 23,28 giant cell arteritis (n ¼ 1), 47 and vasculitis associated with autoimmune diseases (n ¼ 6) 11,16,18,42,58 (see Table 4). Systemic diseases with associated vasculitis included RA (n ¼ 3), 11,16,18 SLE (n ¼ 2), 42,58 and systemic sclerosis (n ¼ 1).…”

“…10,12,46 Among GB-SV patients, 23 (59%) had a biopsy performed in regions other than the GB [9][10][11]14,19,23,32,36,38,40,42,43,45,46,48,50,51,54,60,61 and 82% of them confirmed vasculitis. SV (including GV) was diagnosed at necropsy in 1 patient.…”

“…Among GB-SOV patients, only 3 received glucocorticoids for 6 to 16 weeks, 15,37 whereas all GB-SV patients were treated with glucocorticoids (p ¼ 0.001),; 4,5,9,10,12,14, 16-18,20,22,23,28,31,32,36,38,40,42,43,46 -48,54,58,60,61 54% of patients with SV also received cytotoxic agents 5,12,14,16,17,22,23,31,36,40,42,46,48,58,60 (see Table 2). Among GB-SV patients with adequate information, 17/20 patients were receiving glucocorticoid therapy at the end of …”

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“…14,15 Cases of acute viral hepatitis, both type A and B, associated with acute cholecystitis are found in the literature. 4,15,16 Acute acalculous cholecystitis is a rare condition, accounting for 2-5% of acute cholecystitis, and is usually associated with infections that affect the gallbladder wall, particularly Salmonella Tiphi, but can also occur in cases of systemic vasculitis, streptococcal infections and abdominal traumas. 14 Among the pathophysiological mechanisms, we highlight the direct invasion of the virus in the biliary tract and gallbladder wall, according to a previous report in a patient with hepatitis A virus infection.…”

“…2 Acalculous cholecystitis and pancreatitis are rare extra-hepatic complications of acute HBV infection that may be a differential diagnosis of abdominal pain in these patients. [3][4][5]…”