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Correspondence
Polyarteritis nodosa associated with precore mutant hepatitis B virus infection
  1. M MIGUELEZ,
  2. J BUENO,
  3. P LAYNEZ
  1. Hospital Nuestra Señora de La Candelaria, Internal Medicine Department, Santa Cruz de Tenerife, Canary Islands, Spain
  1. Dr M Morales, C/ Cra General del Norte, Km 15, no 304, 38330 La Laguna, Tenerife, Canary Islands, Spain.

https://doi.org/10.1136/ard.57.3.173

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    Currently there is a trend to support the use of antiviral therapy as the first line treatment of polyarteritis nodosa (PAN) associated to hepatitis B virus (HBV) infection.1 ,2 A combination of a short course of corticosteroids, plasma exchange, and interferon α (INFα) has been proposed. However, we have doubts about this approach in all cases and circumstances of PAN related to HBV infection. One of these circumstances would be precore mutant HBV infection.

    A 37 year old man was diagnosed with PAN. The initial clinical manifestations were mononeuritis multiplex, orchitis, mild renal failure (creatinine: 168 μmol/l, proteinuria of 0.6 g/dl), abdominal pain, and prolonged fever. Leucocytosis (30 000 WBC, 80% neutrophils), serum asparate aminotransferase: 94 U/L, serum alanine aminotransferase: 244U/l, increased erythrocyte sedimentation rate …

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