J Clin Neurol.  2010 Sep;6(3):156-158. 10.3988/jcn.2010.6.3.156.

Mononeuropathy Multiplex in a Patient with Chronic Active Hepatitis B

• Nam TS
• Lee SH
• Park MS
• Choi KH
• Kim JT
• Choi SM
• Kim BC
• Kim MK
• Cho KH

• KMID: 1462853
• DOI: http://doi.org/10.3988/jcn.2010.6.3.156

Abstract

BACKGROUND
Mononeuropathy multiplex is a rare complication during the course of chronic he-patitis B, despite various neuropathies following acute hepatitis B having been reported previously.
CASE REPORT
A 30-year-old man presented with sensorimotor symptoms in multiple peripheral nerves. The serological tests for hepatitis were consistent with chronic active hepatitis B. After treatment with oral prednisone combined with an antiviral agent, the sensory and motor symptoms improved and hepatitis B virus replication was reduced.
CONCLUSIONS
We suggest that chronic immune-mediated neuropathy associated with hepatitis B virus infection should be considered in the differential diagnosis of patients with hepatitis B.

Keyword

chronic hepatitis B; mononeuropathy multiplex

MeSH Terms

Adult
Diagnosis, Differential
Hepatitis
Hepatitis B
Hepatitis B virus
Hepatitis B, Chronic
Hepatitis, Chronic
Humans
Mononeuropathies
Peripheral Nerves
Prednisone
Serologic Tests
Prednisone

Reference

1. Guillevin L, Lhote F, Cohen P, Sauvaget F, Jarrousse B, Lortholary O, et al. Polyarteritis nodosa related to hepatitis B virus. A prospective study with long-term observation of 41 patients. Medicine (Baltimore). 1995. 74:238–253.

2. Tsukada N, Koh CS, Inoue A, Yanagisawa N. Demyelinating neuropathy associated with hepatitis B virus infection. Detection of immune complexes composed of hepatitis B virus surface antigen. J Neurol Sci. 1987. 77:203–216.

3. Berger JR, Ayyar R, Sheremata WA. Guillain-Barré syndrome complicating acute hepatitis B. A case with detailed electrophysiological and immunological studies. Arch Neurol. 1981. 38:366–368.

4. Lightfoot RW Jr, Michel BA, Bloch DA, Hunder GG, Zvaifler NJ, McShane DJ, et al. The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa. Arthritis Rheum. 1990. 33:1088–1093.

5. McMahon BJ, Heyward WL, Templin DW, Clement D, Lanier AP. Hepatitis B-associated polyarteritis nodosa in Alaskan Eskimos: clinical and epidemiologic features and long-term follow-up. Hepatology. 1989. 9:97–101.

6. Bron KM, Strott CA, Shapiro AP. The diagnostic value of angiographic observations in polyarteritis nodosa. A case of mul tiple aneurysms in the visceral organs. Arch Intern Med. 1965. 116:450–454.

7. Hekali P, Kajander H, Pajari R, Stenman S, Somer T. Diagnostic significance of angiographically observed visceral aneurysms with regard to polyarteritis nodosa. Acta Radiol. 1991. 32:143–148.

8. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 36-1985. Accelerated hypertension and impaired renal function in a 24-year-old man with a history of illicit drug abuse and hepatitis B infection. N Engl J Med. 1985. 313:622–631.

9. Sander HW, Latov N. Research criteria for defining patients with CIDP. Neurology. 2003. 60:8 suppl 3. S8–S15.

10. Hanazaki K. Antiviral therapy for chronic hepatitis B: a review. Curr Drug Targets Inflamm Allergy. 2004. 3:63–70.

11. Shusterman N, London WT. Hepatitis B and immune-complex disease. N Engl J Med. 1984. 310:43–46.