Hepatitis B virus induced cytoplasmic antineutrophil cytoplasmic antibody-mediated vasculitis causing subarachnoid hemorrhage, acute transverse myelitis, and nephropathy: a case report

• Published in: Journal of medical case reports Vol. 11; no. 1; p. 91
• Main Authors: Joshi, Utsav, Subedi, Roshan, Gajurel, Bikram Prasad
• Format: Journal Article
• Language: English
• Published: England BioMed Central 03.04.2017; BMC
• Subjects: Adult; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - diagnosis; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - drug therapy; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - virology; Antibodies, Antineutrophil Cytoplasmic - isolation & purification; Antigens; Antiviral Agents - therapeutic use; Back Pain - etiology; Blood; Case Report; Case reports; Cytomegalovirus; Deoxyribonucleic acid; Disease; DNA; Edema - etiology; Guanine - analogs & derivatives; Guanine - therapeutic use; Headache - etiology; Headaches; Health sciences; Hepatitis; Hepatitis B; Hepatitis B virus - isolation & purification; Hospitals; Humans; Immunoglobulins; Infections; Inflammatory diseases; Kidney - pathology; Kidney - virology; Magnetic Resonance Imaging; Male; Methylprednisolone - therapeutic use; Myelitis, Transverse - drug therapy; Myelitis, Transverse - pathology; Myelitis, Transverse - virology; Nephropathy; NMR; Nuclear magnetic resonance; Paraplegia - etiology; Patients; Proteins; Spinal cord; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - diagnostic imaging; Subarachnoid Hemorrhage - pathology; Subarachnoid Hemorrhage - virology; Thoracic Vertebrae - pathology; Thoracic Vertebrae - virology; Tomography; Tomography, X-Ray Computed; Transverse myelitis; Treatment Outcome; Vasculitis; Nephropathy; Vasculitis; Subarachnoid hemorrhage; Hepatitis B; Transverse myelitis
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-017-1255-x

Transverse myelitis, subarachnoid hemorrhage, and nephropathy are established but rare complications of hepatitis B virus infection that can potentially be triggered by an antibody-mediated vasculitis as a result of a viral infection. The following is a case report detailing a patient presenting with all three of the above presentations who is cytoplasmic antineutrophil cytoplasmic antibody-positive and a chronic carrier of hepatitis B. A 33-year-old Nepalese man presented to our hospital with headache, swelling of his body, paraplegia, and back pain that developed over a period of 10 days. Laboratory studies showed proteinuria and elevated levels of serum urea and creatinine. Viral serology was suggestive of chronic inactive hepatitis B carrier state. A computed tomography scan of his head revealed features suggestive of subarachnoid hemorrhage. Magnetic resonance imaging of his dorsal spine showed diffuse T2 high signal intensity within his spinal cord extending from second to 12th thoracic vertebral level which was suggestive of transverse myelitis. The origin of these symptoms was attributed to immune complex-mediated vasculitis after serum analysis for cytoplasmic antineutrophil cytoplasmic antibody came out positive. He was managed with steroids administered orally and intravenously and entecavir administered orally. This case highlights the possibility of a hepatitis B virus-induced vasculitis as the cause of subarachnoid hemorrhage, transverse myelitis, and nephropathy.