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Hepatitis B virus infection associated with polyarteritis nodosa and microscopic polyangiitis
  1. Zhou Meng1,
  2. Wei Cui2,
  3. Lois Arend3 and
  4. Jamal Mikdashi1,4
  1. 1Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland, USA
  2. 2Integrated Medical Care, L.L.C, Rockville, Maryland, USA
  3. 3Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  4. 4Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Jamal Mikdashi; Jmikdash{at}


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.

  • vasculitis
  • connective tissue disease

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  • Contributors Patient care involvement: WC and ZM. Renal biopsy pictures provided by LJA. Drafting the manuscript and revising the manuscript critically for important intellectual content: ZM and JM. Approval of the version of the manuscript to be published: ZM, WC, LJA and JM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.