Chronic leukocytoclastic vasculitis complicating HBV infection. Possible role of mutant forms of HBV in pathogenesis and persistence of disease

Antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis in chronic Hepatitis B: Unraveling the immune puzzle - a rare case report with review of literature

Background

Hepatitis B virus (HBV) infection affects millions worldwide, predominantly targeting the liver, leading to conditions like cirrhosis and hepatocellular cancer. However, HBV can also cause extrahepatic complications, including autoimmune-mediated vasculitis. Small vessel vasculitis, often associated with antineutrophil cytoplasmic antibodies (ANCA), can occur in chronic infections like HBV.

Case presentation

A 46-year-old man with chronic hepatitis B presented with high fever, diarrhoea, and painful black discolouration on his nose, fingers, and toes. Lab results revealed anaemia, leukocytosis, elevated inflammatory markers, positive c-ANCA, and HBV PCR positivity. He was diagnosed with c-ANCA-associated small vessel vasculitis secondary to chronic hepatitis B. Treatment with methylprednisolone followed by tapering prednisolone and azathioprine led to significant improvement in his condition.

Conclusion

This case highlights the rare occurrence of c-ANCA-associated vasculitis in chronic HBV without typical liver symptoms. ANCA testing may aid in early diagnosis and management of such cases. Further research is needed to explore the underlying immunological mechanisms and refine therapeutic approaches.

Hepatitis B virus infection associated with polyarteritis nodosa and microscopic polyangiitis

We reported a unique case with the coexistence of classic and cutaneous polyarteritis nodosa (PAN), and microscopic polyangiitis (MPA) in hepatitis virus-associated vasculitis. A 77-year-old Asian man presented with extremity weakness and weight loss found to have bilateral foot drop and rash on his hands and legs. Labs reveal positive for hepatitis B core antibody and perinuclear-antineutrophil cytoplasmic antibody (p-ANCA), decreased C3 and C4 levels. Skin biopsy of rash shows medium vessel vasculitis suggesting PAN. Interestingly, renal biopsy showed features of necrotising medium-sized arteritis consistent with PAN and focal crescentic glomerulonephritis consistent with MPA. The patient was treated with 1 g of solumedrol daily for 3 days, followed by oral steroids and cyclophosphamide treatment for vasculitis, and entecavir for chronic hepatitis B infection, resulting in resolution of symptoms. The patient has not had a relapse at 6 months.

[Hepatitis B virus infection: Natural history, clinical manifestations and therapeutic approach]

Chronic hepatitis B infection remains a major public-health problem, with approximately 260 million world-wide cases of infection. Recent advances in the understanding of the natural history of chronic hepatitis B infection have led to progress in the care of infected patients. Sustained viral suppression is now possible for a majority of treated patients and is associated with a decrease in the morbidity and mortality attributable to cirrhosis and hepatocellular carcinoma. Complete cure is however not yet possible, due to the long-term persistence of viral DNA in hepatocytes of treated patients. Assessing the risk of viral reactivation in patients receiving immunosuppressive therapy is an increasingly frequent situation in clinical practice and its management is guided by both the patient's serological status and the potency of the immunosuppressive regimen. This review aims to present the clinical and biological presentations of chronic hepatitis B infection, the modalities of antiviral treatment, and how to assess the risk of viral reactivation in patients receiving immunosuppressive therapy.

Vasculitis as a Presenting Manifestation of Chronic Hepatitis B Virus Infection: A Case Report

Hepatitis B virus is responsible for causing hepatic complications like acute and chronic hepatitis, cirrhosis and hepatocellular carcinoma along with some uncommon immune mediated extrahepatic manifestations. Vasculitis remains an uncommon extrahepatic complication of hepatitis B virus infection. Herein we report a case of hepatitis B infection that presented with leucocytoclastic vasculitis as an initial manifestation and managed successfully with entacavir therapy.

Hepatitis B-related autoimmune manifestations

This article focuses on autoimmune manifestations related to the hepatitis B virus (HBV). Although the HBV vaccination has resulted in the decline of the virus, approximately 400 million individuals are infected worldwide. Up to twenty percent of the afflicted may develop extrahepatic manifestations ranging from the severe polyarteritis nodosa to the many, varied, and less severe clinical and biologic forms. Currently, control of the viral infection is mainly based on the use of antiviral drugs (with the current availability of potent agents). Discussion of two hypotheses of the pathophysiology of the virus is followed by descriptions of the general, renal, rheumatologic, neurologic, skin, ophthalmologic, and hematologic manifestations.

Leukocytoclastic vasculitis: is propranolol implicated?

Drugs frequently cause cutaneous adverse reactions. The suspected agent is sometimes difficult to identify, especially in patients receiving multidrug treatment and with underlying illnesses that may contribute to the clinical picture. In our patient, propranolol-induced leukocytoclastic vasculitis was diagnosed by exclusion.