CRYOGLOBULINEMIC VASCULITIS ASSOCIATED WITH HBV INFECTION: CLINICAL OBSERVATIONS AND LITERATURE REVIEW

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Abstract

Description of two clinical cases of chronic HBV hepatitis at cirrhotic stage associated with type III cryoglobulinemia manifested with symptoms of systemic vasculitis is presented in current article. There were no signs of HCV infection in both patients. In first case cutaneous vasulitis appeared after 19 years since serological finding of HBsAg and vasculitis progressed despite steroid therapy. Initiation of antiviral therapy (entecavir 0.5 g/day) induced transient remission. After interruption of antiviral therapy vasculitis reappeared with several vasculitic ulcers on lower legs. Mild improvement of vasculitis was noted after repeated plasmapheresis, steroid and cytostatic treatment with addition of lamivudin. Despite therapy reactivation of HBV infection was detected. Lamivudin was changed to entecavir and rituximab was given in two 500 mg infusions. Combined antiviral and anti-CD20 treatment induced remission of cutaneous vasculitis and healing of leg ulcers. In other case vasculitis manifested after 21 years since detection of HBsAg with cutaneous purpura, arthritis and microhematuria. Entecavir 0.5 g/day induced rapid virological response and complete remission of symptoms related to vasculitis. Similar literature cases were reviewed and available treatment options in refractory cryoglobulinemic vasculitis were discussed.

About the authors

N. V. Dunaeva

Research Institute for Influenza, St. Petersburg

Author for correspondence.
Email: nvch@mail.ru

PhD (Medicine), Associate Professor, Senior Researcher, Division of Experimental and Clinical Investigations,
Research Institute for Influenza

Russian Federation

O. E. Nikitina

Research Institute for Influenza, St. Petersburg

Email: fake@neicon.ru
PhD (Medicine), Senior Researcher, Division of Experimental and Clinical Investigations, Research Institute for Influenza Russian Federation

B. V. Stukov

St. Petersburg State Pediatric Medical University, St. Petersburg

Email: fake@neicon.ru
PhD (Medicine), Associate Professor, Department of Infectious Diseases, St. Petersburg State Pediatric Medical University Russian Federation

V. E. Karev

Research Institute for Children’s Infections, St. Petersburg

Email: fake@neicon.ru
PhD (Medicine), Head of the Laboratory of Pathomorphology, Research Institute for Children’s Infections Russian Federation

A. V. Mazing

St. Petersburg First Pavlov State Medical University, St. Petersburg

Email: fake@neicon.ru
PhD (Medicine), Leading Researcher, Center for Molecular Medicine, St. Petersburg First Pavlov State Medical University Russian Federation

M. Y. Lerner

St. Petersburg First Pavlov State Medical University, St. Petersburg

Email: fake@neicon.ru

Doctor-Laboratory Assistant, Laboratory of Diagnostics of Autoimmune Diseases, Center for Molecular Medicine, St. Petersburg First Pavlov State Medical University

Russian Federation

S. V. Lapin

St. Petersburg First Pavlov State Medical University, St. Petersburg

Email: fake@neicon.ru

PhD (Medicine), Head of the Laboratory of Diagnostics of Autoimmune Diseases, Center for Molecular Medicine, St. Petersburg First Pavlov State Medical University

Russian Federation

Areg A. Totolian

St. Petersburg Pasteur Institute, St. Petersburg

Email: fake@neicon.ru
PhD, MD (Medicine), Corresponding Member of the RAMS, Deputy Director on Science, St. Petersburg Pasteur Institute Russian Federation

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Copyright (c) 2014 Dunaeva N.V., Nikitina O.E., Stukov B.V., Karev V.E., Mazing A.V., Lerner M.Y., Lapin S.V., Totolian A.

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