Description

Some patients with chronic viral hepatitis B develop polyarteritis nodosa. The immune condition often reverts if the viral infection can be successfully treated.


 

Pathogenesis: immune complexes of HBV, immunoglobulin and complement

 

Clinical features:

(1) chronic hepatitis

(2) abdominal pain which may be associated with:

(2a) GI bleeding

(2b) pancreatitis

(2c) infarction of the gallbladder

(3) renal disease

(3a) membranous or membranoproliferative glomerulonephritis with nephrotic syndrome

(3b) renal failure

(3c) severe arterial hypertension

(4) skin rash, which may purpuric, petechial, urticarial, macular, maculopapular, nodular and/or with cutanous infarcts

(5) orchitis in males

(6) mononeuritis multiplex or other peripheral neuropathy

(7) arthralgias and/or polyarthritis

 

Biopsy shows chronic inflammation affecting primarily medium but also small arteries. Immunohistochemistry is often positive for HbsAg.

 

Serologic testing:

(1) positive for HBsAg

(2) may be positive for HBeAg

 


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