Kim Jin Won, Park Shin Young, Kim Nah Ihm, Choi Sung Kyu, Yoon Jae Hyun
Department of Gastroenterology and Hepatology, Chonnam National University Hospital and Medical School, Gwangju 61469, South Korea.
Department of Pathology, Chonnam National University Hospital, Gwangju 61469, South Korea.
World J Clin Cases. 2025 Oct 16;13(29):109516. doi: 10.12998/wjcc.v13.i29.109516.
Hepatitis B virus (HBV) primarily causes hepatic inflammation and has various clinical manifestations. However, extrahepatic reactions, ranging from localized or systemic inflammation, may occur in some cases. Here, we report a case of an acute exacerbation of chronic HBV infection with atypical extrahepatic manifestation confined to the skin and mucosa despite nucleotide analog treatment, which was fully recovered on systemic steroid treatment.
A 53-year-old woman visited a clinic due to worsening skin rash and mucosal inflammation. She was receiving antiviral therapy due to a recent acute exacerbation of chronic HBV infection. While liver function was improving with antiviral treatment, skin rash and mucosal inflammatory lesions gradually worsened. Thus, blood tests and skin biopsy were performed to determine the cause. Despite a thorough review of serum markers and skin biopsy results, a concrete diagnosis revealing other etiology apart from the acute phase of HBV infection could not be established. The cutaneous lesions were considered a rare immunologic extrahepatic manifestation of HBV, warranting systemic steroid treatment. Afterward, both skin and mucosal lesions rapidly improved, and the patient was discharged without any sequelae.
Clinicians should recognize mucocutaneous manifestations of chronic HBV, as systemic steroids may yield favorable outcomes.
乙型肝炎病毒（HBV）主要引起肝脏炎症，并有多种临床表现。然而，在某些情况下可能会出现肝外反应，范围从局部或全身性炎症。在此，我们报告一例慢性HBV感染急性加重且伴有非典型肝外表现的病例，该表现局限于皮肤和黏膜，尽管接受了核苷酸类似物治疗，但经全身类固醇治疗后完全康复。
一名53岁女性因皮疹和黏膜炎症加重就诊于诊所。她因近期慢性HBV感染急性加重而接受抗病毒治疗。虽然抗病毒治疗使肝功能有所改善，但皮疹和黏膜炎症性病变却逐渐加重。因此，进行了血液检查和皮肤活检以确定病因。尽管对血清标志物和皮肤活检结果进行了全面检查，但除了HBV感染急性期外，未能确定其他病因的明确诊断。皮肤病变被认为是HBV罕见的免疫性肝外表现，需要进行全身类固醇治疗。此后，皮肤和黏膜病变迅速改善，患者出院时无任何后遗症。
临床医生应认识到慢性HBV的皮肤黏膜表现，因为全身类固醇治疗可能会产生良好的效果。
