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

Abstract

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)

Polyarteritis nodosa in north India: clinical manifestations and outcomes

“…We noted relapses in 18.5% of our patients and this was similar to the findings in previous series . In addition, all the relapses occurred in non‐HBV‐related PAN, which is similar to other reported series where HBV‐related PAN has a very low relapse rate . There are some studies with no relapses and PAN is considered a monophasic disease .…”

“…Due to the risk of promoting viral replication, currently HBV‐related PAN is treated with short courses of corticosteroids and plasma exchanges along with antivirals. Plasma exchanges are stopped once seroconversion is achieved as HBV‐associated PAN rarely relapses after seroconversion …”

Viral-Associated GN: Hepatitis B and Other Viral Infections

“…PAN in HBV patients is a result of HBsAg antibody immune complexes depositing in medium size blood vessels (24). Compared with idiopathic PAN, HBV patients had a more severe Birmingham Vasculitis Score on presentation, more frequent mesenteric artery aneurysms compared with renal artery involvement, a greater propensity for gastrointestinal vasculitis, less severe skin manifestations, and a more favorable response to therapy with fewer relapses.…”

Polyarteritis nodosa (PAN): is it a single disease?

“…[6] HBV-iliflkili PAN hastalar›nda yap›lan histopatolojik çal›flmalarda virüs ile iliflkili antijenlerin yer ald›¤› antijen-antikor komplekslerinin damar duvar›nda birikti¤i ve tedavi ile bu immün komplekslerin temizlendi¤i gösteril-mifltir. [9] Di¤er taraftan olgu raporlar› fleklinde olsa da hepatit C virüsü ve HIV ile iliflkili olgular da bildirilmifltir. [10,11] Bu hasta grubu son Chapel Hill konferans›nda 'vaskülit iliflkili olas› nedenler' grubunda yer almaktad›r.…”