title: Relapsing-remitting lesions in a woman with progressive hemifacial atrophy and chronic hepatitis B virus infection: A case report.
abstract: BACKGROUND
  Progressive hemifacial atrophy (PHA) is a rare disorder characterized by unilateral facial atrophy affecting the skin, subcutaneous tissue, and fat, muscle, and osteocartilagenous structures creating a sunken hemiface appearance.Etiopathogenesis of PHA is poorly understood; no definitive treatment is currently available.
  
  
  RESULTS
  We report a 41-year-old woman with PHA who showed an uncharacteristic "relapsing-remitting" evolution of brain lesions and was seropositive for hepatitis B virus (HBV). She presented with a history of recurrent tonic-clonic seizures. Magnetic resonance imaging (MRI) showed progressive atrophy and multiple white matter lesions in the left side of the brain. Interestingly, the serial MRI examination (4 MRI scans over a period of 9 years) showed a "relapsing-remitting" pattern of brain lesions akin to that observed in a subtype of multiple sclerosis. Autoimmune-related investigations revealed increased serum levels of immunoglobulin (Ig) G, anti-nuclear antibody (ANA), and γ-IgG. Infection is considered as one of the possible causes of PHA. However, the association of peripheral infection such as HBV infection with PHA has not been reported.
  
  
  CONCLUSIONS
  Our experience with this case suggests that PHA may have a relapsing-remitting disease course. Autoimmune inflammatory response to chronic HBV infection may have triggered the relapse in this case. This case underlines a novel etiopathogenetic mechanism of PHA.
authors.affiliation: Department of Neurology and Neuroscience Center, First Hospital of Jilin University, Xinmin, Changchun, China Department of Neurobiology, Care Sciences & Society, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.forename: Mingqin
authors.initials: M
authors.lastname: Zhu
authors.forename: Xiaozhen
authors.initials: X
authors.lastname: Li
authors.forename: Jing
authors.initials: J
authors.lastname: Miao
authors.forename: Chenchen
authors.initials: C
authors.lastname: Duan
authors.forename: Li
authors.initials: L
authors.lastname: Cui
authors.forename: Xuefan
authors.initials: X
authors.lastname: Yu
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000097:blood; D018450:Disease Progression; D005150:Facial Hemiatrophy / Q000150:complications*; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008279:Magnetic Resonance Imaging; D012640:Seizures / Q000209:etiology
chemical_list: D000974:Antibodies, Antinuclear; D007074:Immunoglobulin G