Successful combination therapy of polyarteritis nodosa associated with a pre-core promoter mutant hepatitis B virus infection.
OBJECTIVE
To describe the clinical and virological evolution of a polyarteritis nodosa (PAN) case associated with a hepatitis B virus (HBV) pre-core promoter mutant infection that was successfully treated with plasma exchanges, corticosteroids, and interferon alpha (IFN-alpha).


METHODS
Viral markers were used, including HBV DNA quantified by the branched DNA assay and detected by PCR, the HBV genome sequence, pre-S1Ag and anti-HBC IgM which were studied throughout the treatment period and the entire follow-up in the serum, while the presence of virus in extrahepatic sites was detected by immuno-staining.


RESULTS
The patient was infected with a typical pre-core promoter mutant harboring four point mutations. Pre-S1Ag was cleared rapidly from serum, most likely via the formation of immune complexes since HBV DNA declined more progressively. Viral infection was then cleared after a second episode of hepatocyte lysis. This was accompanied by a recovery from all clinical manifestations.


CONCLUSIONS
The favorable treatment outcome observed in this first case of pre-core promoter HBV mutant associated PAN underlines that combination therapy based on IFN-alpha can clear pre-core promoter HBV infection and cure PAN. It also provides new insight in the pathogenesis of HBV associated PAN.
Wartelle-Bladou
C
C
Service d'Hépatogastroenterologie, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France.
Lafon
J
J
Trépo
C
C
Pichoud
C
C
Picon
M
M
Pellissier
J F
JF
Zoulim
F
F
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D001483:Base Sequence / Q000235:genetics; D006509:Hepatitis B / Q000150:complications* / Q000235:genetics* / Q000628:therapy; D006515:Hepatitis B virus / Q000235:genetics*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D008969:Molecular Sequence Data; D010951:Plasma Exchange; D017354:Point Mutation; D010488:Polyarteritis Nodosa / Q000473:pathology / Q000821:virology*; D011401:Promoter Regions, Genetic / Q000235:genetics*
D000305:Adrenal Cortex Hormones; D016898:Interferon-alpha