Rodrigo Damith, Perera Ruwan, de Silva Janaka
University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.
J Med Case Rep. 2012 Sep 14;6:305. doi: 10.1186/1752-1947-6-305.
Hepatitis C virus has been under-recognized as an etiologic factor for polyarteritis nodosa and the presence of hepatitis C antigenemia in patients with polyarteritis nodosa has been reported as insignificant. In the literature hepatitis C virus-associated polyarteritis nodosa is a rare and controversial entity.
A 34-year-old Sri Lankan Tamil man presented to our facility with a two-week history of slow-resolving pneumonia of the right mid and lower zones. On physical examination he had panniculitic type tender skin nodules with background livedo reticularis. A skin biopsy was suggestive of a small and medium vessel vasculitis compatible with polyarteritis nodosa. He was tested positive for hepatitis C antibodies. A serum cryoglobulin test was negative but perinuclear antineutrophilic cytoplasmic antibody test was positive. Serum complement levels were reduced. He was diagnosed as having classic polyarteritis nodosa associated with hepatitis C infection. He later developed left-sided radiculopathy involving both upper and lower limbs and an ischemic cardiac event. His hepatitis C infection was managed with polyethylene glycol-interferon 2α combined with oral ribavirin. Simultaneously, his classic polyarteritis nodosa was treated with prednisolone and cyclophosphamide. He made a good recovery.
Hepatitis C virus infection is capable of inducing a fulminant form of vasculitis in the form of polyarteritis nodosa. It may be easily confused early in its course with mixed cryoglobulinemia, which is commonly known to be associated with hepatitis C virus. Awareness of hepatitis C virus-related polyarteritis nodosa helps in diagnosing the condition early so combined immunosuppressive and antiviral treatment can be started as soon as possible.
丙型肝炎病毒一直未被充分认识为结节性多动脉炎的病因，有报道称结节性多动脉炎患者丙型肝炎抗原血症的存在意义不大。在文献中，丙型肝炎病毒相关的结节性多动脉炎是一种罕见且存在争议的疾病。
一名34岁的斯里兰卡泰米尔男子因右中肺和下肺区域的肺炎持续两周未缓解前来我院就诊。体格检查发现他有脂膜炎型压痛性皮肤结节，伴有网状青斑。皮肤活检提示为与结节性多动脉炎相符的中小血管血管炎。他的丙型肝炎抗体检测呈阳性。血清冷球蛋白检测为阴性，但核周抗中性粒细胞胞浆抗体检测为阳性。血清补体水平降低。他被诊断为与丙型肝炎感染相关的经典结节性多动脉炎。后来他出现了累及上下肢的左侧神经根病和一次缺血性心脏事件。他的丙型肝炎感染采用聚乙二醇干扰素2α联合口服利巴韦林进行治疗。同时，他的经典结节性多动脉炎用泼尼松龙和环磷酰胺进行治疗。他恢复良好。
丙型肝炎病毒感染能够诱发结节性多动脉炎形式的暴发性血管炎。在病程早期它可能很容易与通常已知与丙型肝炎病毒相关的混合性冷球蛋白血症相混淆。认识丙型肝炎病毒相关的结节性多动脉炎有助于早期诊断该病，从而能够尽早开始联合免疫抑制和抗病毒治疗。
