Successful combination therapy of polyarteritis nodosa associated with a pre-core promoter mutant hepatitis B virus infection

Background/Aims: To describe the clinical and virological evolution of a po lyarteritis nodosa (PAN) case associated with a hepatitis B virus (HBV) pre -core promoter mutant infection that was successfully treated with plasma e xchanges, corticosteroids, and interferon alpha (IFN-alpha). Methods: Viral markers were used, including HBV DNA quantified by the branc hed DNA assay and detected by PCR, the HBV genome sequence, pre-S1Ag and an ti-HBC IgM which were studied throughout the treatment period and the entir e follow-up in the serum, while the presence of virus in extrahepatic sites was detected by immune-staining. Results: The patient was infected with a typical pre-core promoter mutant h arboring four point mutations. Pre-S1Ag was cleared rapidly from serum, mos t likely via the formation of immune complexes since HBV DNA declined more progressively. Viral infection was then cleared after a second episode of h epatocyte lysis, This was accompanied by a recovery from all clinical manif estations. Conclusions: The favorable treatment outcome observed in this first case of pre-core promoter HBV mutant associated PAN underlines that combination th erapy based on IFN-alpha can clear pre-core promoter HBV infection and cure PAN. It also provides new insight in the pathogenesis of HBV associated PA N, (C) 2001 European Association for the Study of the Liver, Published by E lsevier Science B.V. All rights reserved.