Successful combination therapy of polyarteritis nodosa associated with a pre-core promoter mutant hepatitis B virus infection

J Hepatol. 2001 May;34(5):774-9. doi: 10.1016/s0168-8278(00)00088-x.

Abstract

Background/aims: 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.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Aged
  • Base Sequence / genetics
  • Hepatitis B / complications*
  • Hepatitis B / genetics*
  • Hepatitis B / therapy
  • Hepatitis B virus / genetics*
  • Humans
  • Interferon-alpha / therapeutic use
  • Male
  • Molecular Sequence Data
  • Plasma Exchange
  • Point Mutation*
  • Polyarteritis Nodosa / pathology
  • Polyarteritis Nodosa / virology*
  • Promoter Regions, Genetic / genetics*

Substances

  • Adrenal Cortex Hormones
  • Interferon-alpha