The case of a young female patient with
chronic active hepatitis B, vasculitic
purpura,
edema, and circulating
immune complexes due to mixed
cryoglobulinemia is described. Serum
transaminases were elevated. Serological assays showed
hepatitis B surface antigen (
HBsAg), antibody to
hepatitis B e antigen (anti-HBe), and antibody to
hepatitis B core antigen (anti-HBc)
antibodies but no antibody to hepatitis C virus (anti-HCV) or antibody to hepatitis delta virus (anti-HDV)
antibodies. Using hepatitis B virus-polymerase chain reaction (HBV-PCR) and direct sequencing a precore/core (preC/C) mutant unable to synthesize
HBeAg was detected in serum. HBV
antigens were demonstrated in the circulating
immune complexes. Following 1 month of treatment with
interferon-alpha 2b3 miu three times weekly,
alanine aminotransferases returned to normal levels while
cryoglobulins and
immune complexes disappeared from serum. In addition, 2 months after the onset of treatment serum HBV-
DNA was no longer detectable by PCR. Prior to treatment the analysis of cellular immune reactions of peripheral blood mononuclear cells showed a major proliferative response to
HBcAg, preS1Ag and HBxAg and a minor response to
HBeAg and
HBsAg. One month after conclusion of treatment a decline in T-cell reactivity against all HBV
antigens was observed. During clinical response to the
therapy, however, a strong proliferative response of T cells to
HBcAg and
HBeAg was demonstrated. In conclusion,
immune complex disease may complicate
chronic hepatitis B in patients expressing HBe-minus HBV mutants. Treatment with
interferon-alpha was found to be effective in mixed
cryoglobulinemia even in the presence of HBe-minus HBV mutants.(ABSTRACT TRUNCATED AT 250 WORDS)