Systemic polyarteritis nodosa following hepatitis B vaccination

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Systemic polyarteritis nodosa following hepatitis B vaccination

Jozélio Freire de Carvalhoab1, Rodrigues Pereiraa, Yehuda

Shoenfeldb2

Received 22 February 2007; received in revised form 22 June 2007;

accepted 28 June 2007. published online 23 April 2008.

Abstract

The authors report a patient who developed systemic polyarteritis

nodosa two months after hepatitis B vaccination and review the

literature concerning this vaccination and the development of

autoimmune conditions, mainly vasculitis. A 14-year-old boy who had

no relevant previous history and who was not taking any drugs

presented with a livedo reticularis, fever, loss of weight,

testicular pain, and paresthesias two months after receiving the

third dose of a hepatitis B vaccination. Inflammatory parameters (ESR

and CRP) were high. The patient met the ACR diagnostic criteria for

polyarteritis nodosa. He received corticosteroids and

immunosuppressants and showed improvement. After reviewing the 27

cases of vasculitis after hepatitis B vaccination reported in the

current literature, the authors suggest that, in some cases,

vaccination may be the triggering factor for vasculitis in

individuals with a genetic predisposition. Physicians should be aware

of this possible association.