High Hepatitis B Viral Load in Severe Polyarteritis Nodosa

One of the extra-hepatic manifestations of hepatitis B virus (HBV) is polyarteritis nodosa (PAN). It may involve mediumand small-sized arteries in any organ. Coexistence of these two disease conditions may be life threatening, thus, both conditions should be treated. Herein, we report on a patient with severe PAN. The patient was an 18-year-old man with multiple progressive wounds in skin, who referred to Baqiyatallah Hospital. Skin biopsy showed vasculitis compatible with PAN. He had been treated with low dose prednisolone and lamivudin for three years; however, his condition deteriorated and ulcers in his leg became life-threatening. The hepatitis B Viral load was 17,000,000 copy/mL. The wound developed a superimposed resistant bacterial infection. He was then treated with two antiviral drugs (lamivudin 100 mg/day plus adofovir 10 mg/day), high dose cyclophosphamide (750 mg once monthly) and prednisolone (60 mg/day for one month). After six months, the viral load dropped to 100,000 copy/mL; the wounds were also improved. We concluded that high viral load of HBV associates with severity of PAN. We recommend combination therapy with two antiviral agents plus high dose immunosuppressive drugs until both disease conditions resolve remarkably.