Review article
Systemic polyarteritis nodosa following hepatitis B vaccination

https://doi.org/10.1016/j.ejim.2007.06.035Get rights and content

Abstract

The authors report a patient who developed systemic polyarteritis nodosa two months after hepatitis B vaccination and review the literature concerning this vaccination and the development of autoimmune conditions, mainly vasculitis. A 14-year-old boy who had no relevant previous history and who was not taking any drugs presented with a livedo reticularis, fever, loss of weight, testicular pain, and paresthesias two months after receiving the third dose of a hepatitis B vaccination. Inflammatory parameters (ESR and CRP) were high. The patient met the ACR diagnostic criteria for polyarteritis nodosa. He received corticosteroids and immunosuppressants and showed improvement. After reviewing the 27 cases of vasculitis after hepatitis B vaccination reported in the current literature, the authors suggest that, in some cases, vaccination may be the triggering factor for vasculitis in individuals with a genetic predisposition. Physicians should be aware of this possible association.

Introduction

Rheumatologic manifestations following hepatitis B (HB) vaccination have been studied and described in increasing detail in recent years [1]. Polyarteritis nodosa (PAN) is a rare, life-threatening, necrotizing vasculitis that affects medium-sized arteries and has a well-documented association with HB virus [2]. Multiple case reports have suggested a link between PAN and HB vaccination [3], [4], [5], [6], [7], [8] that may be the result of widespread immunization with this vaccine, which was introduced in the late 1980s and is the second most frequently administered vaccine in the United States [9]. It is universally recommended by the Centers for Disease Control (CDC) for infants as well as for selected high-risk adults [10].

The authors review the literature on this issue as well as a new case of PAN that appeared after receiving HB vaccination.

Section snippets

Discussion

Hepatitis B vaccination is frequently prescribed. The CDC recommends this vaccine for all individuals, but mainly for those at risk of getting this infection, such as health care professionals [10]. The vaccine most often involved with autoimmunity is the HB vaccine [11]. There is a wide spectrum of diseases and autoimmune manifestations associated with this vaccine, as shown in Table 1.

Conclusion

Although it is impossible to determine a causal effect based on only one individual case, the present case, together with the many others described in the literature and the strong temporal association observed in both the present and other studies, should alert physicians to the possibility that the development of PAN may be a rare side effect of HB vaccination. Moreover, there have been numerous instances in which the gift of immunization has proved to be a ”Trojan horse” that generated an

Learning points

  • Autoimmune disorders can appear after HB vaccination.

  • The vaccine most often involved with autoimmunity is HB vaccine.

  • The association between HB vaccine and autoimmunity is temporal only, and no certain causality has been proven.

  • The risks of HB vaccination in lupus are very small; nevertheless, it should be considered in the context of the individual's exposure risk.

  • In the current literature, there are 27 descriptions of vasculitis after HB vaccine.

  • Vaccination can have adverse autoimmune effects

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    1

    JF Carvalho is a recipient of grant no. BEX 2367/06-8 awarded by CAPES.

    2

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