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End-Stage Renal Disease, Autoimmune Hepatitis, Alveolar Hemorrhage and ANCA Vasculitis as a Complication of Chronic Hepatitis B Virus: An Unusual Case Report

Received: 31 January 2023     Accepted: 24 February 2023     Published: 9 March 2023
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Abstract

Background: End stage renal disease, autoimmune hepatitis and alveolar hemorrhage have rarely been reported as the 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 was a case report detailing a patient presenting with all three of the above presentations who was cytoplasmic antineutrophil cytoplasmic antibody-positive and a chronic carrier of hepatitis B virus. Case presentation: A 52-year-old Malagasy woman presented in our intensive care unit for acute respiratory failure with end-stage renal disease and deterioration in general condition. She was managed with steroids, non-invasive ventilation, and hemodialysis. Laboratory test showed elevated levels of serum creatinine and liver enzymes. An extensive workup was done to find the etiology of elevated liver enzymes. Only blood work that came back positive was for chronic inactive hepatitis virus B and positive autoantibody suggestive of autoimmune hepatitis. A computed tomography scan of her lung revealed features suggestive of bilateral alveolar hemorrhage. Workup for other causes of vasculitis, including anti-neutrophil cytoplasmic antibodies (ANCA) was positive for c-ANCA antibody to proteinase 3. Medical investigations allowed excluding other infectious diseases, malignancies and other rheumatic and vasculitis affections. Administration of lamivudine® orally was done. The patient was followed for more than one year and there were no other new systematic symptoms. Conclusion: This case report showed the possibility of hepatitis B virus-induced vasculitis as the cause of alveolar hemorrhage, autoimmune hepatitis, and end stage renal disease. The origin of these symptoms was attributed to immune complex-mediated vasculitis induced by antineutrophil cytoplasmic antibody.

Published in World Journal of Medical Case Reports (Volume 4, Issue 1)
DOI 10.11648/j.wjmcr.20230401.12
Page(s) 9-13
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

End-Stage Renal Disease, Acute Respiratory Failure, Antineutrophil Cytoplasmic Antibody, Hepatitis B Virus

References
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[2] Calhan T, Sahin A, Kahraman R, Altunoz ME, Ozbakir F, Ozdil K, Sokmen HM. Antineutrophil Cytoplasmic Antibody Frequency in Chronic Hepatitis B Patients. Dis Markers 2014; 2014: 982150.
[3] Teng GG, Chatham WW. Vasculitis related to viral and other microbial agents. Best Pract Res Clin Rheumatol. 2015; 29 (2): 226-243.
[4] Christen U, Hintermann E. Pathogens and autoimmune hepatitis. Clin Exp immunol 2019; 195: 35-51.
[5] Nasser M, Cottin V. Alveolar hemorrhage in vasculitis (primary and secondary). Semir Respir Crit Care Med 2018; 39: 482-493.
[6] Zhou TB, Jiang ZP. Is there an association of hepatitis B virus infection with minimal change disease of nephrotic syndrome? A clinical observational report. Ren Fail 2015; 37 (3): 459-461.
[7] Goddard J, Turner AN. Kidney and urinary tract disease. In: Walker BR, Colledge NR, Ralston SH, Penman I, editors. Davidson’s Principles and Practice of Medicine. 22nd ed. Toronto: Elsevier Health Sciences 2013; 461-524.
[8] Joshi U, Subedi R, Gajurel BP. Hepatitis B virus induced cytoplasmic antineutrophil cytoplasmic antibody-mediated vasculitis causing subarachnoid hemorrhage, acute transverse myelitis, and nephropathy: a case report. J Med Case Rep 2017; 11: 91. DOI 10.1186/s13256-017-1255-x.
[9] Singh H, Tanwar VS, Sukhija G, Kaur P, Govil N. Vasculitis as a Presenting Manifestation of Chronic Hepatitis B Virus Infection: A Case Report. J Clin Diagn Res 2016; 10 (2): OD25-26.
[10] Sebode M, Weiler-Normann C, Liwinski T, Schramm C. Autoantibodies in Autoimmune Liver Disease-Clinical and Diagnostic Relevance. Front Immunol 2018; 9:609. doi: 10.3389/fimmu.2018.00609.
[11] Pawlowska M, Halota W. Acute liver failure caused by concurrent autoimmune hepatitis and hepatitis B in a 16-year old girl. World Journal of Hepatology 2010; 2 (10): 392-394.
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[15] Fabrizi F, Donato FM, Messa P. Association Between Hepatitis B Virus and Chronic Kidney Disease: a Systematic Review and Meta-analysis. Annals of hepatology 2017; 16 (1): 21-47.
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[17] Cordier JF, Cottin V. Alveolar hemorrhage in vasculitis: primary and secondary. Semin Respir Crit Care Med 2011; 32 (3): 310-321.
[18] Harold R. Collard, Marvin I. Schwarz. Diffuse alveolar hemorrhage. Clin Chest Med 2004; 25 (3): 583-592, vii. doi: 10.1016/j.ccm.2004.04.007.
[19] Wang KR, Zhou FY. Diffuse alveolar hemorrhage in a patient with ANCA-associated vasculitis after thyroidectomy. Medicine (Baltimore) 2019; 98 (8): e14630.
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Cite This Article
  • APA Style

    Ernestho-Ghoud Indretsy Mahavivola, Soilihi Moustafa Abdou, Vita Odon Anthony, Rajaonarison Ny Ony Narindra Lova Hasina, Ahmad Ahmad, et al. (2023). End-Stage Renal Disease, Autoimmune Hepatitis, Alveolar Hemorrhage and ANCA Vasculitis as a Complication of Chronic Hepatitis B Virus: An Unusual Case Report. World Journal of Medical Case Reports, 4(1), 9-13. https://doi.org/10.11648/j.wjmcr.20230401.12

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    ACS Style

    Ernestho-Ghoud Indretsy Mahavivola; Soilihi Moustafa Abdou; Vita Odon Anthony; Rajaonarison Ny Ony Narindra Lova Hasina; Ahmad Ahmad, et al. End-Stage Renal Disease, Autoimmune Hepatitis, Alveolar Hemorrhage and ANCA Vasculitis as a Complication of Chronic Hepatitis B Virus: An Unusual Case Report. World J. Med. Case Rep. 2023, 4(1), 9-13. doi: 10.11648/j.wjmcr.20230401.12

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    AMA Style

    Ernestho-Ghoud Indretsy Mahavivola, Soilihi Moustafa Abdou, Vita Odon Anthony, Rajaonarison Ny Ony Narindra Lova Hasina, Ahmad Ahmad, et al. End-Stage Renal Disease, Autoimmune Hepatitis, Alveolar Hemorrhage and ANCA Vasculitis as a Complication of Chronic Hepatitis B Virus: An Unusual Case Report. World J Med Case Rep. 2023;4(1):9-13. doi: 10.11648/j.wjmcr.20230401.12

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  • @article{10.11648/j.wjmcr.20230401.12,
      author = {Ernestho-Ghoud Indretsy Mahavivola and Soilihi Moustafa Abdou and Vita Odon Anthony and Rajaonarison Ny Ony Narindra Lova Hasina and Ahmad Ahmad and Rakotoarison Ratsaraharimanana Catherine Nicole and Raveloson Nasolotsiry Enintsoa and Vololontiana Hanta Marie Danielle},
      title = {End-Stage Renal Disease, Autoimmune Hepatitis, Alveolar Hemorrhage and ANCA Vasculitis as a Complication of Chronic Hepatitis B Virus: An Unusual Case Report},
      journal = {World Journal of Medical Case Reports},
      volume = {4},
      number = {1},
      pages = {9-13},
      doi = {10.11648/j.wjmcr.20230401.12},
      url = {https://doi.org/10.11648/j.wjmcr.20230401.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjmcr.20230401.12},
      abstract = {Background: End stage renal disease, autoimmune hepatitis and alveolar hemorrhage have rarely been reported as the 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 was a case report detailing a patient presenting with all three of the above presentations who was cytoplasmic antineutrophil cytoplasmic antibody-positive and a chronic carrier of hepatitis B virus. Case presentation: A 52-year-old Malagasy woman presented in our intensive care unit for acute respiratory failure with end-stage renal disease and deterioration in general condition. She was managed with steroids, non-invasive ventilation, and hemodialysis. Laboratory test showed elevated levels of serum creatinine and liver enzymes. An extensive workup was done to find the etiology of elevated liver enzymes. Only blood work that came back positive was for chronic inactive hepatitis virus B and positive autoantibody suggestive of autoimmune hepatitis. A computed tomography scan of her lung revealed features suggestive of bilateral alveolar hemorrhage. Workup for other causes of vasculitis, including anti-neutrophil cytoplasmic antibodies (ANCA) was positive for c-ANCA antibody to proteinase 3. Medical investigations allowed excluding other infectious diseases, malignancies and other rheumatic and vasculitis affections. Administration of lamivudine® orally was done. The patient was followed for more than one year and there were no other new systematic symptoms. Conclusion: This case report showed the possibility of hepatitis B virus-induced vasculitis as the cause of alveolar hemorrhage, autoimmune hepatitis, and end stage renal disease. The origin of these symptoms was attributed to immune complex-mediated vasculitis induced by antineutrophil cytoplasmic antibody.},
     year = {2023}
    }
    

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  • TY  - JOUR
    T1  - End-Stage Renal Disease, Autoimmune Hepatitis, Alveolar Hemorrhage and ANCA Vasculitis as a Complication of Chronic Hepatitis B Virus: An Unusual Case Report
    AU  - Ernestho-Ghoud Indretsy Mahavivola
    AU  - Soilihi Moustafa Abdou
    AU  - Vita Odon Anthony
    AU  - Rajaonarison Ny Ony Narindra Lova Hasina
    AU  - Ahmad Ahmad
    AU  - Rakotoarison Ratsaraharimanana Catherine Nicole
    AU  - Raveloson Nasolotsiry Enintsoa
    AU  - Vololontiana Hanta Marie Danielle
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    DO  - 10.11648/j.wjmcr.20230401.12
    T2  - World Journal of Medical Case Reports
    JF  - World Journal of Medical Case Reports
    JO  - World Journal of Medical Case Reports
    SP  - 9
    EP  - 13
    PB  - Science Publishing Group
    SN  - 2994-726X
    UR  - https://doi.org/10.11648/j.wjmcr.20230401.12
    AB  - Background: End stage renal disease, autoimmune hepatitis and alveolar hemorrhage have rarely been reported as the 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 was a case report detailing a patient presenting with all three of the above presentations who was cytoplasmic antineutrophil cytoplasmic antibody-positive and a chronic carrier of hepatitis B virus. Case presentation: A 52-year-old Malagasy woman presented in our intensive care unit for acute respiratory failure with end-stage renal disease and deterioration in general condition. She was managed with steroids, non-invasive ventilation, and hemodialysis. Laboratory test showed elevated levels of serum creatinine and liver enzymes. An extensive workup was done to find the etiology of elevated liver enzymes. Only blood work that came back positive was for chronic inactive hepatitis virus B and positive autoantibody suggestive of autoimmune hepatitis. A computed tomography scan of her lung revealed features suggestive of bilateral alveolar hemorrhage. Workup for other causes of vasculitis, including anti-neutrophil cytoplasmic antibodies (ANCA) was positive for c-ANCA antibody to proteinase 3. Medical investigations allowed excluding other infectious diseases, malignancies and other rheumatic and vasculitis affections. Administration of lamivudine® orally was done. The patient was followed for more than one year and there were no other new systematic symptoms. Conclusion: This case report showed the possibility of hepatitis B virus-induced vasculitis as the cause of alveolar hemorrhage, autoimmune hepatitis, and end stage renal disease. The origin of these symptoms was attributed to immune complex-mediated vasculitis induced by antineutrophil cytoplasmic antibody.
    VL  - 4
    IS  - 1
    ER  - 

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Author Information
  • Internal medicine Unit, Private Medical Clinic, Antananarivo, Madagascar

  • Intensive Care Unit, University Hospital Center, Andohatapenaka, Antananarivo, Madagascar

  • Intensive Care Unit, University Hospital Center, Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar

  • Medical Imaging Unit, University Hospital Center, Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar

  • Medical Imaging Unit, University Hospital Center, Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar

  • Intensive Care Unit, University Hospital Center, Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar

  • Intensive Care Unit, University Hospital Center, Andohatapenaka, Antananarivo, Madagascar

  • Internal medicine Unit, University Hospital Center, Joseph Raseta Befelatanana, Antananarivo, Madagascar

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