Small vessel vasculitis caused by hepatitis B virus immune complexes. Small vessel vasculitis and HBsAG.
In a comprehensive study of 80 patients with vasculitis, 4 had concurrent hepatitis B virus (HBV) infection. Polyarteritis nodosa was present in 2 and in the other 2, cutaneous vasculitis, presenting clinically as palpable or Henoch-Schönlein purpura. In one of these patients skin biopsies demonstrated granular deposits of IgM, C3, C4, and the hepatitis B surface antigen (HBsAg) and electron-dense deposits of aggregated 20-nm particles resembling HBsAg in postcapillary venules. Evidence for circulating HBsAg-immune complexes included increased serum Clq binding activity, decreased serum complement, and a cryoprecipitate containing both HBsAg and IgM anti-HBs. Aggregated 20-nm particles resembling intact HBsAg were also seen by negative staining electron microscopy of the serum cryoprecipitate. This patient fulfills all the criteria for a specific immune complex vasculitis caused by his immune response to a chronic HBV infection. These findings emphasize that HBV infection may be associated with small vessel vasculitis as well as polyarteritis nodosa, mixed cryoglobulinemia, and glomerulonephritis. A similar immune response to other viral infections may be expressed as palpable (Henoch-Schönlein) purpura also.
D000328:Adult; D000914:Antibodies, Viral; D000936:Antigen-Antibody Complex; D001706:Biopsy; D006510:Hepatitis B Antibodies; D006511:Hepatitis B Antigens; D006801:Humans; D011695:IgA Vasculitis / Q000209:etiology*; D008099:Liver / Q000473:pathology; D008297:Male; D012867:Skin / Q000473:pathology
D000914:Antibodies, Viral; D000936:Antigen-Antibody Complex; D006510:Hepatitis B Antibodies; D006511:Hepatitis B Antigens