Rapid improvement of distal vasculitis in PAN related to hepatitis B with alprostadil infusion: a case report

Abstract

Polyarteritis nodosa (PAN) related to hepatitis B is an uncommon vasculitis that is sometimes associated with the rapid progression of distal ischemia. A few recent reports have proposed the use of antiviral therapy. However, there is not yet a consensus for the standard treatment of this disease entity and none of these treatments have been focused on fast symptomatic improvement. We describe here a 39-year-old female patient with PAN related to hepatitis B infection who completely recovered from the acutely progressing ischemic manifestations of her distal extremities with the use of alprostadil infusion (prostaglandin E1). The reactivation of her hepatitis B infection after glucocorticoid and cyclophosphamide therapy was successfully managed by the antiviral lamuvudine therapy. Most importantly, the vasodilator together with the conventional therapy may be desirable in the early stages of the disease before irreversible ischemic tissue damage can occur.

Bone marrow‐derived mesenchymal stem cells are capable of mediating hepatitis B virus infection in injured tissues

“…Supportively, a HBV-related vasculitis, i.e. polyarteritis nodosa has been shown to be highly associated with the rapid progression of distal ischaemia [36]. It is not clear whether the HBV-related extrahepatic diseases are commonly associated with tissue injury.…”

Blue Toe Syndrome in Behçet’s Disease: A Case Report

“…These actions elevate transcutaneous oxygen pressures and expedite wound healing [26][27][28], in addition to alleviating vascular inflammation [29]. PGE1, along with immunosuppressants, has been used to treat vasculitisrelated digital ischemia in patients with rheumatologic conditions like polyarteritis nodosa and rheumatoid arthritis [30][31][32]. The patient in this case report was successfully managed through both medical and surgical means, employing a combination of anti-platelets, steroids, colchicine, alprostadil (PGE1), and toe amputation.…”

Advances in the Diagnosis and Treatment of Vasculitis

“…Vasodilator and antithrombotic agents may be used together with other drugs and have been especially promoted to be used in patients with skin ulcers and necrosis (Choi SW et al, 2006;Gonzalez-Fernandez MA & Garcia-Consuegra J, 2007;Lim MJ et al, 2006;Zulian F et al, 2004;Zulian F et al, 1998).…”