title: Acute onset distal symmetrical vasculitic polyneuropathy associated with acute hepatitis B.
abstract: Hepatitis B can have varied extrahepatic manifestations involving the skin, renal, haematological and nervous systems. Neurological manifestations in hepatitis B may take the form of Guillain-Barré syndrome and secondary systemic vasculitis-related mononeuritis multiplex. The clinical course of hepatitis B-related, vasculitis-related neuropathy is usually subacute to chronic and clinical evolution is relatively benign. To our knowledge, acute hepatitis B-associated vasculitis manifesting as acute distal symmetric polyneuropathy has not been reported. We report a 60-year-old man who presented with fever, mild hepatomegaly, skin lesions in the form of non-palpable purpura and acute onset distal symmetric sensorimotor polyneuropathy. Serum transaminase levels were raised and viral serological markers revealed acute hepatitis B. The patient remained anicteric throughout his clinical course. Nerve conduction studies showed severe axonal sensorimotor polyneuropathy and histopathological examination of sural nerve biopsy was suggestive of vasculitic neuropathy. The patient was first given a course of intravenous immunoglobulin with the antiviral drug entecavir. The fever subsided after 1 week of treatment. The patient was started on prednisolone in addition to the entecavir, and showed significant improvement in motor power and marked resolution in paresthesia after 2 weeks of treatment. Thus, acute onset distal symmetric sensorimotor polyneuropathy of vasculitic etiology can be a manifestation of acute hepatitis B.
authors.affiliation: Department of Neurology, Room 511, Academic Block, GB Pant Hospital, JLN Marg, New Delhi-2 110002, India.
authors.forename: Manmohan
authors.initials: M
authors.lastname: Mehndiratta
authors.forename: Sanjay
authors.initials: S
authors.lastname: Pandey
authors.forename: Rajeev
authors.initials: R
authors.lastname: Nayak
authors.forename: Ravindra K
authors.initials: RK
authors.lastname: Saran
mesh_terms: D000208:Acute Disease; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011115:Polyneuropathies / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D014657:Vasculitis / Q000150:complications / Q000175:diagnosis* / Q000821:virology