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Treatment of hepatitis B virus-related polyarteritis nodosa: two case reports and a review of the literature

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Abstract

A substantial number of cases of polyarteritis nodosa (PAN) are related to hepatitis B virus (HBV) infection. Different treatment strategies are reported in the literature. The aim of this study was to review 15 years of literature (1988–2002) to determine the optimal treatment for HBV-related PAN at present, and to discuss the indications and mechanism of action of corticosteroids in HBV-related PAN, as many physicians are reluctant to use these in the presence of HBV infection. The first patient stopped his initial treatment, relapsed and died of cerebral infarction. The second case illustrates the favorable outcome with the standard treatment: corticosteroids, lamivudine and plasma exchanges. If adequate follow-up is possible, antiviral agents as well as corticosteroids are indicated in HBV-related PAN. Corticosteroids diminish inflammation and corticosteroid withdrawal induces an alanine aminotransferase (ALT) rebound in patients with a low baseline ALT level. Antiviral agents are essential, as they reduce the production of HBV antigens and help to achieve hepatitis B early antigen (HBeAg) seroconversion. Plasma exchanges reduce the level of circulating immune complexes and are included in the treatment protocol of all recent studies. However, their effect has not been evaluated in controlled trials. We concluded that if adequate follow-up is possible, antiviral agents as well as corticosteroids are indicated in HBV-related PAN.

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Abbreviations

ALT:

Alanine aminotransferase

HBV:

Hepatitis B virus

PAN:

Polyarteritis nodosa

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Authors and Affiliations

  1. Department of Internal Medicine, Campus Stuivenberg, Algemeen Centrumziekenhuis Antwerpen, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium

    D. H. Deeren, M. L. N. G. Malbrain & H. Verbraeken

  2. Department of Radiology, Campus Stuivenberg, Algemeen Centrumziekenhuis Antwerpen, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium

    A. I. De Backer

  3. Department of General Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium

    D. Blockmans

Authors
  1. D. H. Deeren
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  2. A. I. De Backer
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  3. M. L. N. G. Malbrain
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  4. H. Verbraeken
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  5. D. Blockmans
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Correspondence to D. H. Deeren.

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Deeren, D.H., De Backer, A.I., Malbrain, M.L.N.G. et al. Treatment of hepatitis B virus-related polyarteritis nodosa: two case reports and a review of the literature. Clin Rheumatol 23, 172–176 (2004). https://doi.org/10.1007/s10067-003-0857-4

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  • DOI: https://doi.org/10.1007/s10067-003-0857-4

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