title: HBV-associated cryoglobulinemic vasculitis: remission after antiviral therapy with entecavir.
abstract: OBJECTIVE
  Cryoglobulinemic vasculitis remains an uncommon complication of hepatitis B virus infection.
  
  
  METHODS
  We report the case of a 40-years old female Chinese patient with chronic hepatitis B developing cryoglobulinemic vasculitis with multiple organ involvement (liver, kidney, and skin) coupled with weakness, arthralgias, haemolytic anaemia, and autoimmune thyroiditis. She received entecavir mono-therapy at dose adjusted for estimated glomerular filtration rate.
  
  
  RESULTS
  Within five months of entecavir treatment, hepatitis B viraemia decreased below the limit of detection with normal serum amino-transferase levels, HBeAg clearance occurred, vasculitis regressed with disappearance of purpura and ascites; in addition, renal function normalized and nephritic syndrome remitted. After a five-year follow-up, the patient is asymptomatic with intact kidney function, proteinuria in the normal range, and normal liver biochemistry, despite the antiviral treatment was withdrawn and the patient remained HBsAg positive.
  
  
  CONCLUSIONS
  This is the second case of hepatitis B virus-related cryoglobulinemic vasculitis successfully treated with entecavir suggesting that effective antiviral therapy may counteract both the hepatic and extra-hepatic manifestations of infection by hepatitis B virus.
authors.affiliation: Division of Hepatology, S. Giuseppe Hospital and University School of Medicine, Milano, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Viganò
authors.forename: Paul
authors.initials: P
authors.lastname: Martin
authors.forename: Mattia
authors.initials: M
authors.lastname: Cappelletti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fabrizi
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D015897:Comorbidity; D003449:Cryoglobulinemia / Q000188:drug therapy* / Q000209:etiology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D012074:Remission Induction; D000637:Transaminases / Q000097:blood; D016896:Treatment Outcome; D014657:Vasculitis / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens; C413685:entecavir; D006147:Guanine; D000637:Transaminases