Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2019; 7(10): 1206-1212
Published online May 26, 2019. doi: 10.12998/wjcc.v7.i10.1206
Hepatitis B virus-related liver cirrhosis complicated with dermatomyositis: A case report
Juan Zhang, Xiao-Yu Wen, Run-Ping Gao
Juan Zhang, Xiao-Yu Wen, Run-Ping Gao, Department of Hepatic-Biliary-Pancreatic Medicine, the First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Author contributions: Wen XY and Gao RP designed the study and took care of the patient. Zhang J collected the clinical data and wrote the manuscript. Wen XY and Gao RP revised the manuscript. Wen XY and Gao RP are co-corresponding authors.
Supported by Natural Science Foundation of Jilin Science and Technology Department, No. 20190201065JC.
Informed consent statement: The patient and his family members provided written informed consent.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016) and prepared the manuscript accordingly.
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/
Corresponding author: Run-Ping Gao, MD, PhD, Professor, Department of Hepatic-Biliary-Pancreatic Medicine, The First Hospital of Jilin University, No. 71 Xinmin Avenue, Changchun 130021, Jilin Province, China. gaorp@jlu.edu.cn
Telephone: +86-431-88785110 Fax: +86-431-65612468
Received: January 16, 2019
Peer-review started: January 17, 2019
First decision: March 10, 2019
Revised: March 25, 2019
Accepted: April 9, 2019
Article in press: April 9, 2019
Published online: May 26, 2019
Processing time: 130 Days and 19.2 Hours
Abstract
BACKGROUND

Twenty percent of patients infected with hepatitis B virus (HBV) develop extrahepatic manifestations with HBV detected in the lymph nodes, spleen, bone marrow, kidneys, and skin. HBV infection has been associated with some autoimmune disorders. Dermatomyositis (DM) is an idiopathic inflammatory myopathy, which involves a viral infection, and DM has been identified in patients infected with HBV, but there is no direct histological evidence for an association between HBV and DM.

CASE SUMMARY

We describe a familial HBV-infected patient admitted with liver function abnormality, rashes, a movement disorder, and an elevated level of creatine kinase (CK). A computed tomography scan of the lung showed pulmonary fibrosis, and a liver biopsy identified nodular cirrhosis. An electromyogram revealed myogenic damage, and a muscle biopsy showed nuclear migration in local sarcolemma and infiltration of chronic inflammatory cells. Immunohistochemical staining showed negative results for HBsAg and HBcAg. Fluorescence in situ hybridization showed a negative result for HBV DNA. The patient was diagnosed with HBV-related liver cirrhosis complicated with DM and was treated with methylprednisolone, mycophenolate mofetil, and lamivudine. Eight months later, the patient was readmitted for anorexia and fatigue. The blood examination showed elevated levels of aminotransferases and HBV DNA, however, the CK level was within the normal range. The patient developed a virological breakthrough and lamivudine was replaced with tenofovir.

CONCLUSION

DM in chronic HBV-infected patients does not always associate with HBV. Antiviral and immunosuppressive drugs should be taken into consideration.

Keywords: Chronic hepatitis B; Dermatomyositis; Extrahepatic manifestations; Case report

Core tip: We report a patient diagnosed with hepatitis B virus (HBV)-related liver cirrhosis complicated with dermatomyositis (DM). However, HBV was not detected in his muscle sample, thus we concluded that his DM did not associate with his HBV infection. Diagnosis of DM on the basis of HBV infection is relatively uncommon. Diagnosis and treatment are difficult due to the complex relationship between these diseases and their conflicting treatment strategies. By providing our experience in diagnosing and treating DM with HBV, we hope to assist with similar cases and to stimulate further research on the relationship between DM and HBV.