Hepatitis B Virus Infection Mimicking Systemic Lupus Erythematosus: A Case Report Of Child And Literature Review

Objective:Hepatitis B virus infection not only leads to liver disease,but also results in a spectrum of extrahepatic manifestations which may be observed in up to 20%of patients infected with Hepatitis B virus.Several of these manifestations have been described,including serum sickness-like syndrome,glomerulonephritis,polyarthritis,polyarteritis nodosa,dermatologic condition,cryoglobulinemia and the production of autoantibodies,which are nonspecific for Hepatitis B virus infection.However,Hepatitis B virus infection mimicking systemic lupus erythematosus hasn't been reported.Here we report a boy with Hepatitis B virus infection mimicking systemic lupus erythematosus to improve the understanding of extrahepatic manifestations of hepatitis B virus infection and systemic lupus erythematosus-like lesions.patient&methods:A 9-year-old Chinese boy was admitted to Department of Pediatrics,Fuzong Clinical Medical College of Fujian Medical University for painful swollen joints,rash and proteinuria.We asked for a medical history of the child and performed a medical examination.Complete blood count,urinalysis,blood biochemistry,autoantibodies,C3 levels,C4 levels,pathogens such as Hepatitis B virus,Hepatitis C virus,human immunodeficiency virus and Epstein-Barr virus were detected,and a renal biopsy was performed.We prescribed IV methylprednisolone 48 mg once a day for 2 weeks,then gradually tapered and stopped it after 6 weeks,and meanwhile,oral entecavir 0.5 mg once a day for 3 months.Then we performed close observation in1 year.At last we studied the case according to the symptoms,signs,laboratory examination,treatment effect of the child,combining with literature review.Results:One month before admission,pain and swelling occurred in the patient's both lower limbs,concomitant with a nonpruritic rash on the lower limbs.Physical examination revealed palpable purpura on his buttocks and both lower limbs.Laboratory findings showed nephrotic proteinuria,hematuria,C4 levels<0.07g/L,C31.08g/L,ANA 1:100 and anti-dsDNA positive.The copies of serum Hepatitis B virus DNA were 1.6×10~8,but other viral markers including Hepatitis C virus,human immunodeficiency virus,Epstein-Barr virus were negative.Light microscopy examination of the renal tissue revealed glomerular mesangial cell proliferation.Immunohistochemical analysis showed glomerular vascular loops staining for IgM,IgG,C3d and C4d,and glomerular mesangial region staining for IgA and C1q,and glomerular basement membrane staining for HBsAg.Electron microscopy image revealed glomerular mesangial cell proliferation and electron dense in glomerular mesangial region.After treating with 8 weeks of methylprednisolone and 3 months of entecavir,the patient's rash disappeared and he no longer felt joint pain.Laboratory findings showed urinary albumin negative,urinary occult blood test negative,C4 0.156g/L,ANA and anti-dsDNA negative,the copies of serum Hepatitis B virus DNA were4.88×10~4.Close observation for 1 year,the patient still had no rash,hair loss,joint pain,photosensitivity.laboratory findings showed his urinary albumin negative,urinary occult blood negative,C4 0.147g/L,ANA 1:100 and anti-dsDNA positive.And the copies of serum Hepatitis B virus DNA were 1.12×10~8.Conclusions:HBV infection can mimic SLE,which suggests the necessity to exclude HBV infection when clinically suspected SLE.