乙型肝炎病毒感染与结节性多动脉炎和显微镜下多血管炎相关。
Hepatitis B virus infection associated with polyarteritis nodosa and microscopic polyangiitis.
机构信息
Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland, USA.
Integrated Medical Care, L.L.C, Rockville, Maryland, USA.
出版信息
BMJ Case Rep. 2021 May 19;14(5):e240015. doi: 10.1136/bcr-2020-240015.
We reported a unique case with the coexistence of classic and cutaneous polyarteritis nodosa (PAN), and microscopic polyangiitis (MPA) in hepatitis virus-associated vasculitis. A 77-year-old Asian man presented with extremity weakness and weight loss found to have bilateral foot drop and rash on his hands and legs. Labs reveal positive for hepatitis B core antibody and perinuclear-antineutrophil cytoplasmic antibody (p-ANCA), decreased C3 and C4 levels. Skin biopsy of rash shows medium vessel vasculitis suggesting PAN. Interestingly, renal biopsy showed features of necrotising medium-sized arteritis consistent with PAN and focal crescentic glomerulonephritis consistent with MPA. The patient was treated with 1 g of solumedrol daily for 3 days, followed by oral steroids and cyclophosphamide treatment for vasculitis, and entecavir for chronic hepatitis B infection, resulting in resolution of symptoms. The patient has not had a relapse at 6 months.
我们报告了一例伴有经典型和皮肤型结节性多动脉炎（PAN）以及乙型肝炎病毒相关性血管炎中小血管显微镜下多血管炎（MPA）共存的特殊病例。一名 77 岁亚裔男性因四肢无力和体重减轻就诊，发现双侧足下垂和手部及腿部皮疹。实验室检查示乙型肝炎核心抗体和核周型抗中性粒细胞胞质抗体（p-ANCA）阳性，C3 和 C4 水平降低。皮疹皮肤活检显示中等血管血管炎，提示为 PAN。有趣的是，肾活检显示为坏死性中等大小动脉炎，符合 PAN，以及局灶性新月体性肾小球肾炎，符合 MPA。患者接受了 1g 甲泼尼龙静脉滴注 3 天，随后接受口服类固醇和环磷酰胺治疗血管炎，以及恩替卡韦治疗慢性乙型肝炎感染，症状得到缓解。患者在 6 个月时未复发。
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