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DOI: 10.48087/BJMS.2025.130202
Authors: Nadir BENABDERRAHMANE1, Mohamed Lyes DJAMA1, Hayet BACHA1, Yasmine BAGHDALI2, Hind ARZOUR2, Hayat KHALFAT3, Charaf Amir ZINE3, Malika BOUCELMA1
Affiliations: 1- Internal medicine department, Bachir Mentouri Hospital, Algiers, Algeria. 2- Nephrology department, Mustapha Bacha Hospital, Algiers, Algeria. 3- Anatomopathology departement, Mustapha Bacha Hospital, Algiers, Algeria.
Keywords: Polyarteritis nodosa, Hepatitis B, Vasculitis, Plasmapheresis, Antiviral therapy.
Abstract
Polyarteritis nodosa (PAN) is a necrotizing vasculitis affecting medium and small arteries. Its secondary form linked to hepatitis B virus (HBV-PAN) has become rare. This report describes a 49-year-old Algerian woman with HBV-PAN presenting with prolonged fever. She exhibited fever, fatigue, leg edema, rash, elevated inflammatory markers, mild proteinuria, and elevated liver enzymes. Workup revealed acute hepatitis B infection. During admission, she developed sensorimotor polyneuropathy, diffuse abdominal pain, myocarditis with heart failure, and severe hypertension. Renal biopsy confirmed PAN with fibrinoid necrosis of small vessels, fulfilling the ACR 1990 criteria. Treatment included tenofovir, nine plasma exchange sessions, corticosteroid pulses followed by oral prednisone, and rehabilitation. The clinical course improved significantly, with resolution of pain, recovery of neurological function, and stabilization of cardiac and renal function. However, at six-month follow-up, hepatitis B remained chronic, posing an ongoing relapse risk. HBV-associated PAN is now rare but remains a severe condition. It should be suspected in patients presenting with systemic vasculitic symptoms and positive HBV serology. Combined therapy with antivirals, corticosteroids, and plasmapheresis can lead to favorable outcomes.