The Association of Hepatitis B and Polymyositis: Rare but Real

Abstract

Aims: Hepatitis B virus infection is a global health concern. Although Hepatitis B virus primarily affects hepatocytes, it sometimes develops disease manifestations outside the liver and can present as full fledged proximal myopathy. 
 Presentation of Case: We report a 68-year-old man presenting with progressive proximal bilateral lower limb weakness for the last 14 days. The weakness was associated with pain and one episode of fever. Examination revealed 3/5 power in the shoulder and hip joint without any sensory deficit. Biochemical investigation showed elevated CPK levels (1102 IU/L) and liver enzymes (AST – 625 IU/L, ALT – 356 IU/L). HBsAg and HBeAg came out to be positive with HBV DNA of 73000 copies/mL. MRI shoulder and hip joints revealed diffuse intramuscular and myofascial edema suggesting inflammatory myositis. Muscle biopsy was suggestive of Necrotizing Autoimmune Myopathy.
 Discussion: Patient symptoms improved after starting IV Prednisolone and Entecavir therapy suggesting a close association between Hepatitis B infection and myopathy.
 Conclusion: Although Hepatitis B virus primarily affects hepatocytes, it sometimes develops disease manifestations outside the liver, such as Polymyositis. Therefore, it is imperative to screen for Viral markers in these patients.

Polymyositis concomitant with hepatitis B virus infection: Treatment challenges

“…In this case, treatment became challenging due to hepatitis B. The association between polymyositis and hepatitis B remain unclear, but the presence of antibody complexes against the hepatitis B antigen in muscle raises the possibility that link hepatitis B with polymyositis as triggering antigen [ 21 ]. It is also supported with the increase of myositis-associated antibodies found in patient with HBV infection more than patient without HBV infection [ 22 ].…”