Li MR, Li LY, Tang J, Sun J. Chronic hepatitis B triggering antineutrophil cytoplasmic antibody-associated vasculitis complicated by glomerulonephritis: A case report. World J Clin Cases 2025; 13(19): 102212 [DOI: 10.12998/wjcc.v13.i19.102212]
Corresponding Author of This Article
Jian Sun, Chief Physician, MD, PhD, Professor, Department of Nephrology and Rheumatology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Changsha 410013, Hunan Province, China. sunjian105@sina.com
Research Domain of This Article
Rheumatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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/
Chronic hepatitis B triggering antineutrophil cytoplasmic antibody-associated vasculitis complicated by glomerulonephritis: A case report
Ming-Ru Li, Li-Ya Li, Juan Tang, Jian Sun
Ming-Ru Li, Jian Sun, Department of Nephrology and Rheumatology, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan Province, China
Li-Ya Li, Department of Rheumatology and Immunology, Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Juan Tang, Department of Nephrology, Central South University, Changsha 410013, Hunan Province, China
Author contributions: Li MR collected the materials and drafted the manuscript; Li LY and Tang J revised the content of the manuscript; Sun J contributed to critically revising the manuscript for important intellectual content and offered unique insights into the clinical data and valuable suggestions for improving the manuscript; and all authors gave final approval for the version to be submitted.
Supported by the Natural Science Foundation of Hunan Province, China, No. 2023JJ30842.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian Sun, Chief Physician, MD, PhD, Professor, Department of Nephrology and Rheumatology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Changsha 410013, Hunan Province, China. sunjian105@sina.com
Received: October 11, 2024 Revised: January 19, 2025 Accepted: February 28, 2025 Published online: July 6, 2025 Processing time: 158 Days and 13.8 Hours
Abstract
BACKGROUND
Hepatitis B virus (HBV) infection can lead to renal involvement, commonly manifested as HBV-associated glomerulonephritis (HBV-GN), which typically presents as nephrotic or nephritic syndrome. Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is a systemic disease characterized by immune necrotizing inflammation of small blood vessels involving multiple organs with complex and severe clinical implications. The coexistence of HBV-GN and AAV is sporadic, with limited data existing regarding its diagnosis, management, clinical outcomes, and prognosis, especially in patients with AAV.
CASE SUMMARY
This manuscript presents the case of an older male patient who presented with persistent foamy urine lasting over two weeks. Initial clinical findings included nephrotic syndrome and renal insufficiency, which subsequently progressed to involve the lungs, immune system, hematologic system, and other organ systems. The patient was diagnosed with HBV-GN complicated by AAV, a rare and complex condition. Despite receiving comprehensive treatment, including corticosteroids, cyclophosphamide for immune regulation, plasma exchange, and immunoadsorption targeting antineutrophil cytoplasmic antibody-associated antibodies, the patient required long-term dialysis and demonstrated a poor prognosis.
CONCLUSION
HBV infection may trigger nephropathy with AAV. Early recognition and intervention are crucial for improving patient prognosis.
Core Tip: This case highlights a 63-year-old man diagnosed with hepatitis B virus-related nephropathy complicated by antineutrophil cytoplasmic antibody-associated vasculitis. Despite undergoing treatments such as plasma exchange, protein A immunoadsorption, and immune modulation, the patient suffered dual renal insults, necessitating maintenance dialysis and resulting in a poor prognosis. Chronic hepatitis B virus infection may contribute to antineutrophil cytoplasmic antibody production, emphasizing the importance of early diagnosis and proactive clearance of immune complexes to improve outcomes in similar cases.
