Hepatotropic viral infection associated systemic vasculitides-hepatitis B virus associated polyarteritis nodosa and hepatitis C virus associated cryoglobulinemic vasculitis

J Clin Exp Hepatol. 2013 Sep;3(3):204-12. doi: 10.1016/j.jceh.2013.06.001. Epub 2013 Jul 8.

Abstract

Two hepatotropic viruses have been shown to have causal relationship with systemic vasculitis-hepatitis B with classical polyarteritis nodosa and hepatitis C with cryoglobulinemic vasculitis. The present paper provides an updated overview on the clinical presentations and management of these vasculitides. HBV associated PAN patients have higher weight loss, peripheral neuropathy, mononeuritis multiplex, abdominal pain, gastrointestinal manifestations requiring surgery, cardiomyopathy, orchitis, hypertension, and/or elevated transaminase levels. Microaneurysms are also more common in mesenteric artery. Skin manifestations, however are less common. These patients also have a severe disease as suggested by higher five factor score and higher BVAS. Though relapses are less common, mortality is higher in patients with HBV PAN as compared to non HBV PAN. Plasmapheresis has a role in treatment in clearing off immune complexes. The common clinical manifestations of HCV associated cryoglobulinemic vasculitis are skin lesions, peripheral neuropathy, glomerulonephritis, arthritis, and sicca symptoms. Though combination therapy comprising of pegylated interferon α and ribavirin is the first line of management, immunotherapy is needed for severe or life threatening manifestations. Recent randomized trials have shown the efficacy of rituximab in such situations.

Keywords: ANCA, anti neutrophilic cytoplasmic antibodies; BVAS, Birmingham vasculitis activity score; CHCC, Chapel Hill Consensus classification criteria; FFS, five factor score; FVG, French vasculitis group; HBV; HBV, hepatitis b virus; HBV, hepatitis c virus; HCV; MPA, microscopic polyangiitis; MPO, myeloperoxidase; PAN, polyarteritis nodosa; PE, plasma exchange; cryoglobulinemic vasculitis; polyarteritis nodosa.

Publication types

  • Review