Successful Peginterferon-Alfa (PEG-IFN-α) treatment of a chronic hepatitis B (CHB) patient complicated with periarteritis nodosa. A case report

Introduction: Extrahepatic manifestations of HBV infection are rare, but can be difficult to diagnose and manage. HBV can sometimes cause skin rash, arthritis, glomerulonephritis, polyarteritis nodosa (PAN), glomerulonephritis, polyneuropathy and papular acrodermatitis. Case report: A 61-year-old male smoker was admitted to rheumatology unit with multiple arterial stenoses and a severe Raynaud phenomenon with necroses of the fingers on both hands and polyarthritis, predominantly in the lower limbs. The levels of transaminases were elevated, with an ALAT predominance. Anti-HCV and numerous autoimmune tests and rheumatoid factor were negative, without sign of cryoproteins. The HBsAg and HBV DNA PCR were positive. The patient then presented at the Department of the Rare Diseases, where the background of the weight loss and the muscular atrophy of the four limbs strongly suggested a non-typical form of HBV-associated PAN. The HBeAg test was positive, while anti-HBe was negative. A PEG-IFN-α2a therapy started in August 2010. After 3 months, the pt returned to us for control. At that time, he felt some improvement of his muscle stiffness, but was still confined to a wheelchair. We did not observe any serious side-effects of the medication; only a mild itch had appeared because of the dry skin. One month later there was a transient ischaemic attack with speech disorder and right-side limb weakness, but the symptoms disappeared within an hour. Antiaggregant therapy improved the cerebral circulation. At the end of the 48 week antiviral treatment, the ALAT was normal, HBsAg, HBeAg, HBV DNA PCR were negative and anti-HBs and anti-HBe were positive, which indicated a complete seroconversion. After a 3-month follow-up, his mobility was improved significantly, and he could walk without help. After 1 year, the virological response was sustained and the ALAT normal. Conclusions: Although the causality in this case is particularly clear, we draw attention to a possible complication, potentially the first sign of HBV infection. Additionally, a polymorbid patient can be treated safely with PEG-IFN-α2a.