Life-Threatening Complications of Hepatitis B Virus-Related Polyarteritis Nodosa Developing Despite Interferon-α_2b Therapy: Successful Treatment with a Combination of Interferon, Lamivudine, Plasma Exchanges and Steroids

Abstract

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-α_2b (IFN-α_2b) monotherapy, developed life-threatening complications with bowel perforation. He was thereafter successfully treated with a combination of IFN-α_2b, lamivudine, plasma exchanges and short-term steroids. In contrast to IFN-α_2b, 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.