For hepatitis B virus associated
polyarteritis nodosa,
alpha interferon and
plasma exchanges have been proposed to be the first-line treatment. We report a case of
hepatitis B surface antigen (
HBsAg)-positive fulminant
polyarteritis nodosa with predominant gastrointestinal involvement who showed good response to pulse
cyclophosphamide,
prednisolone, and
lamivudine therapy. The patient, a 22-year-old man, presented with a short history of epigastric
pain. Initial upper gastrointestinal endoscopy revealed
gastritis and duodenal erosions. His
pain did not respond to H2-receptor antagonists. He had slightly impaired liver function tests, and was
HBsAg and
hepatitis B e antigen (
HBeAg) positive. Around 3 weeks after initial presentation, he developed massive gastrointestinal haemorrhage requiring
resuscitation and emergency
laparotomy. Microscopic examination of the resection specimens revealed necrotizing
vasculitis of small and medium-sized arteries in the submucosa compatible with
polyarteritis nodosa. The patient was treated with pulse
cyclophosphamide and
prednisolone, with
lamivudine being added when he showed an acute rise in liver
enzymes. He subsequently developed
HBeAg seroconversion, and remained well 18 months after cessation of all immunosuppressives. We believe that the efficacy of pulse
cyclophosphamide,
prednisolone, and
lamivudine in the treatment of hepatitis B virus associated
polyarteritis nodosa, especially in comparison with
interferon and
plasma exchanges, deserves further evaluation.