Life-threatening complications of hepatitis B virus-related polyarteritis nodosa developing despite interferon-alpha2b therapy: successful treatment with a combination of interferon, lamivudine, plasma exchanges and steroids.
Polyarteritis nodosa (PAN) is a rare vasculitis associated with hepatitis B virus (HBV) infection in a significant proportion of cases. When used to treat HBV-related PAN, immunosuppressive agents may enhance viral replication and relaspes are frequent. In recent years the use of antiviral drugs has been proposed. We report the case of a patient with HBV-related PAN who, despite 6 weeks of interferon-alpha2b (IFN-alpha2b) monotherapy, developed life-threatening complications with bowel perforation. He was thereafter successfully treated with a combination of IFN-alpha2b, lamivudine, plasma exchanges and short-term steroids. In contrast to IFN-alpha2b, lamivudine is effective in rapidly suppressing viral replication. This may be valuable in the treatment of HBV-related PAN by contributing to a faster diminution of circulating immune complex levels. This case report highlights the importance of aggressive combined therapy in patients with HBV-related PAN.
Deléaval
P
P
Hôpital Cantonal, Fribourg, Switzerland.
Stadler
P
P
Descombes
E
E
Hecker
E
E
Schrago
G
G
Chizzolini
C
C
Nicole
A
A
Pugin
P
P
Regamey
C
C
D000328:Adult; D003131:Combined Modality Therapy; D016638:Critical Illness; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006515:Hepatitis B virus / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage*; D019259:Lamivudine / Q000008:administration & dosage*; D010951:Plasma Exchange / Q000379:methods*; D010488:Polyarteritis Nodosa / Q000175:diagnosis / Q000628:therapy* / Q000821:virology*; D011994:Recombinant Proteins; D018570:Risk Assessment; D013256:Steroids / Q000008:administration & dosage*; D016896:Treatment Outcome
D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D013256:Steroids; D019259:Lamivudine