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HBV-Associated PAN — SCE Rheumatology MCQ

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HardVasculitisHBV-Associated PANSCE Rheumatology

A 62-year-old man with ANCA-negative medium vessel vasculitis with hepatitis B has testicular pain mononeuritis multiplex and mesenteric ischaemia. Angiography shows renal microaneurysms. What is the specific treatment approach for hepatitis B-associated polyarteritis nodosa?

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Correct answer: E — Antiviral therapy for hepatitis B combined with plasma exchange and short-course glucocorticoids

Hepatitis B-associated PAN requires a specific treatment approach distinct from idiopathic PAN. The strategy involves antiviral therapy to eradicate HBV (the underlying trigger) combined with short-course glucocorticoids to control the acute vasculitis and plasma exchange to remove circulating immune complexes. Prolonged immunosuppression should be avoided as it can promote viral replication. Successful HBV seroconversion typically leads to vasculitis remission. This differs from idiopathic PAN where more prolonged immunosuppression is appropriate.

Reference: Guillevin L et al 2005 HBV-PAN treatment; ACR 1990 PAN criteria