Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2016; 4(3): 94-98
Published online Mar 16, 2016. doi: 10.12998/wjcc.v4.i3.94
Hypertension in the liver clinic - polyarteritis nodosa in a patient with hepatitis B
Shalini Thapar Laroia, Suman Lata
Shalini Thapar Laroia, Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
Suman Lata, Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
Author contributions: Laroia ST worked on concept, design, clinical and imaging work up, data acquisition, analysis and manuscript writing; Lata S did the clinical data interpretation and helped in editing of the manuscript; Laroia ST designed the study and wrote the manuscript.
Institutional review board statement: The Institute of Liver and Biliary sciences Institutional review board does not require retrospective case report study with adequate patient consent form to be put up for ethical approval.
Informed consent statement: All study participants provided informed written consent prior to study enrolment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest whatsoever including but not limited to commercial, personal, political, intellectual, or religious interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shalini Thapar Laroia, Associate professor, Department of Radiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110070, India. thaparshalini@gmail.com
Telephone: +91-95-40950977 Fax: +91-11-26806356
Received: June 4, 2015
Peer-review started: June 10, 2015
First decision: August 15, 2015
Revised: October 14, 2015
Accepted: November 13, 2015
Article in press: November 17, 2015
Published online: March 16, 2016
Abstract

Chronic hepatitis caused by hepatitis B virus (HBV) is an endemic disease in India. It is associated with extrahepatic manifestations like polyarteritis nodosa (PAN) which is a vasculitis like disorder, presenting in subacute or chronic phase; involving visceral and systemic vessels. It should always be considered as a possible etiology of hypertension in an underlying setting of hepatitis B. We describe a 56-year-male patient with a history of chronic HBV who presented to the outpatient clinic with history of recent onset hypertension and suspected liver disease. Further work up for the cause of recent hypertension included a contrast computerized tomography of abdomen, which revealed concomitant pathologies of chronic liver disease and multiple aneurysms in bilateral kidneys. This case illustrates the unusual presentation of extrahepatic manifestation of viral hepatitis in the form of PAN of kidneys. PAN as an independent entity may be missed in specialized clinics evaluating liver pathologies, due to its insidious onset, atypical clinical symptoms and multi-systemic manifestations. The knowledge of extrahepatic, renal and vascular manifestations of hepatitis B unrelated to liver disease should be considered by physicians at the time of diagnosis and management of patients with HBV.

Keywords: Hepatitis B, Polyarteritis nodosa, Hypertension, Liver, Extra-hepatic, Vascular

Core tip: Extra hepatic manifestation of viral hepatitis B infection may be its first presenting symptom. This unusual presentation may be in the form of hypertension in a middle aged patient which is usually a part of vasculitis like disease process such as polyarteritis nodosa (PAN). PAN as an independent entity may be missed in specialized clinics evaluating liver pathologies, due to its insidious onset, atypical clinical symptoms and multi-systemic involvement. It is prudent for diagnosticians and physicians to be aware of this entity and its imaging features, which may help as pointers to its diagnosis.