ESPN 51th Annual Meeting

ESPN 2018


 
RARE EXTRAHEPATIC MANIFESTATIONS OF HEPATITIS B: SERUM SICKNESS LIKE DISEASE and IgA NEPHRITIS
FATMA MUTLUBAŞ 1 EREN SOYALTIN 1 CANER ALPARSLAN 1 EMEL TEKİN 3 SEÇİL ARSLANSOYU ÇAMLAR 1 DEMET ALAYGUT 1 BELDE KASAP DEMIR 2 EDA ÖNCEL 4 GÜLDEN DİNİZ 3 ÖNDER YAVAŞCAN 1

1- IZMIR TEPECIK TRAINING AND RESEARCH HOSPITAL DEPARTMENT OF PEDIATRICS DIVISION OF NEPHROLOGY, IZMIR, TURKEY
2- IZMIR KATIP ÇELEBI UNIVERSITY DEPARTMENT OF PEDIATRICS DIVISION OF NEPHROLOGY, IZMIR, TURKEY
3- IZMIR TEPECIK TRAINING AND RESEARCH HOSPITAL DEPARTMENT OF PATHOLOGY, IZMIR, TURKEY
4- IZMIR TEPECIK TRAINING AND RESEARCH HOSPITAL PEDIATRIC INFECTIOUS DISEASE DEPARTMENT , IZMIR, TURKEY
 
Introduction:

Hepatitis B infection is associated with also extrahepatic syndromes. Serum sickness like disease is one of these manifestations which is seen with arthritis and dermatitis, firstly. We aimed to discuss a rare complication of chronic hepatitis B named IgA nephritis after serum sickness disease.

Material and methods:

16-years-old girl followed up with chronic hepatitis B for 15 years admitted with arthralgia and eruptions seemed like Henoch-Schloein Purpura lesions in distal parts of upper-lower extremities. Arthritis was present in the ankles of the patient with arthralgia on his elbows. The other system examinations were normal. Complete blood count, liver and renal functions and acute phase reactants were in normal ranges. Urine analysis revealed microscopic hematuria and mild (<500 mg/dl) proteinuria. Treatment support was only NSAID for arthritis. Skin findings advanced to necrotic lesions in second day and a skin biopsy was performed and resulted as erythema multiforme. No deposition with immunofluorescent. Advanced analysis for vasculitis was planned: ANA: 1/640, C3: 64.8 (>80mg/dl), C4: normal, profile of ANA: negative, p-ANCA and c-ANCA, Antids-DNA and cryoglobulin tests were negative. HBV-DNA was 986x106copy/ml which was higher than recent copies. 

Results:

With high HBV-DNA copies, arthritis, erythema multiforme, and hypocomplementemia, patient was accepted as serum sickness like disease. 10 days later urine protein progressed to 1.5gr/dl, so a renal biopsy was performed. Endocapiller proliferation and double contour sign was viewed in glomerular basement membranes. Hepatitis B antigen (HBAg) has been demonstrated by the immunofluorescent technique in mesangial areas and the patient demonstrated as IgA nephritis secondary to Hepatitis B virus infection.   

Conclusions:

 Although HBV infection is recognized as affecting hepatocytes, it is important to be aware of the spectrum of extrahepatic manifestations associated with this infection.