Hepatitis B-related polyarteritis nodosa complicated by pulmonary hemorrhage

A 34-year-old man presented with fever, weight loss, paresthesia, abdominal pain, and hypertension. He had hepatitis B antigenemia, with negative anti neutrophil cytoplasmic antibody, antinuclear antibody, and antiglomerular b asement membrane serology results. Renal arteriography showed multiple intr arenal microaneurysms, In spite of therapy with antiviral agents (lamivudin e, famciclovir), prednisone, cyclophosphamide, and plasmapheresis, renal fu nction deteriorated. He later developed rapidly progressive dyspnea and hem optysis. Diffuse alveolar hemorrhage was confirmed by bronchoscopy. He died of respiratory failure, The cause of pulmonary hemorrhage in this case of polyarteritis nodosa is unclear, but may include underlying capillaritis, c ocaine-induced pulmonary hemorrhage, or recurrent attacks of malignant hype rtension.