Hepatitis B Virus-Related Polyarteritis Nodosa Presenting With Multiple Lung Nodules and Cavitary Lesions

The course of hepatic diseases may be complicated by a multitude of rheumatologic manifestations, which can complicate the diagnostic approach and alter the natural history of primary liver disease, sometimes worsening prognosis due to associated multiple organ dysfunction. These manifestations can occur in association with a multitude of liver diseases, including viral hepatitis, autoimmune hepatitis, alcoholic liver disease, nonalcoholic fatty liver disease, hemochromatosis, or Wilson's disease. It is necessary not only for rheumatologists, but also for other clinicians, to be aware that these atypical manifestations may reflect an undiagnosed hepatic disease. On the other hand, it is crucial that, in a patient with known hepatic disease presenting with rheumatologic symptoms, an accurate distinction be made between the rheumatologic manifestations of hepatic disease and primary rheumatologic disease, since the treatment is often different. This review aims to summarize the current evidence regarding rheumatologic manifestations of hepatic diseases, how to distinguish them from primary rheumatologic disorders, and how to provide adequate management.

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“…An excellent response to a combination of glucocorticoids and entecavir has been demonstrated. Similar results are expected for tenofovir [58].…”

Section: Hepatitis Bsupporting

confidence: 88%

Rheumatologic manifestations of hepatic diseases

Fernandes¹,

Dias

Mascarenhas

et al. 2019

aog

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“…Lungs are usually spared in PAN, though a case of HBV associated PAN patient with multiple lung nodules has been reported in which nongranulomatous necrotizing vasculitis involving small pulmonary arteries was confirmed. 21 Variable degree of renal insufficiency may occur due to vascular nephropathy and renal infarction. Presence of glomerulonephritis goes against the diagnosis of classical PAN.…”

Section: Clinical Featuresmentioning

confidence: 99%

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

Sharma

2013

Journal of Clinical and Experimental Hepatology

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Two hepatotropic viruses have been shown to have causal relationship with systemic vasculitis-hepatitis B with classical polyarteritis nodosa and hepatitis C with cryoglobulinemic vasculitis. The present paper provides an updated overview on the clinical presentations and management of these vasculitides.HBV associated PAN patients have higher weight loss, peripheral neuropathy, mononeuritis multiplex, abdominal pain, gastrointestinal manifestations requiring surgery, cardiomyopathy, orchitis, hypertension, and/or elevated transaminase levels. Microaneurysms are also more common in mesenteric artery. Skin manifestations, however are less common. These patients also have a severe disease as suggested by higher five factor score and higher BVAS. Though relapses are less common, mortality is higher in patients with HBV PAN as compared to non HBV PAN. Plasmapheresis has a role in treatment in clearing off immune complexes.The common clinical manifestations of HCV associated cryoglobulinemic vasculitis are skin lesions, peripheral neuropathy, glomerulonephritis, arthritis, and sicca symptoms. Though combination therapy comprising of pegylated interferon a and ribavirin is the first line of management, immunotherapy is needed for severe or life threatening manifestations. Recent randomized trials have shown the efficacy of rituximab in such situations. ( J CLIN EXP HEPATOL 2013;3:204-212)

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“…Naniwa et al reported one case presenting with multiple lung nodules, similar to the current case, although without granulomatous changes. That case turned out to be HBV-PAN (17). The current case demonstrated pathological rarity in light of its lung-limited GPA-like inflammation due to HBV infection, contributing to the diversity among reports of HBV-associated vasculitis.…”

Section: Discussionmentioning

confidence: 98%

Hepatitis B Virus-associated Vasculitis: Multiple Cavitary Masses in the Lung Mimicking Granulomatous Polyangiitis

et al. 2019

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Hepatitis B virus (HBV) is one of the main causes of polyarteritis nodosa (PAN). We herein report a rare case of HBV-associated vasculitis presenting with multiple pulmonary nodules, mimicking granulomatous polyangiitis (GPA), with no abnormalities of the ear, nose, or kidney. A surgical lung biopsy revealed geographic necrosis surrounded by palisading granuloma and capillaritis. Because the HBV surface antigen was positive with a serum HBV-DNA level of 2.9 log10 copies/mL, we first treated the patient with entecavir and 2 weeks of prednisone 50 mg/day. The pulmonary nodules resolved, and seroconversion was observed after one month.

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Hepatitis B Virus-Related Polyarteritis Nodosa Presenting With Multiple Lung Nodules and Cavitary Lesions

Cited by 12 publications

References 9 publications

Rheumatologic manifestations of hepatic diseases

Rheumatologic manifestations of hepatic diseases

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

Hepatitis B Virus-associated Vasculitis: Multiple Cavitary Masses in the Lung Mimicking Granulomatous Polyangiitis

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