Abstract

We report the case of a 50‐year‐old woman affected by a chronic latent Hepatitis B (H.B.V.) virus infection since the age of 35, who complained of several relapses of sub‐acute sensorimotor inflammatory polyneuropathy with albumino‐cytological dissociation, successfully treated with IVIg pulse therapy during acute phase and with chronic prednisone therapy. An exacerbation of H.B.V. infection, likely induced by corticosteroid administration, associated with marked increase in serum of hepatic enzymes and high H.B.V. DNA levels in blood, coincided with a severe worsening of the neuropathy. Laboratory investigations revealed, among others, elements of renal involvement (hypoalbuminemia, proteinuria). Immunofixation electrophoresis revealed an IgM (k) monoclonal gammopathy, antibody testing high level of IgM to GD1a (1/81920). Lamivudina, rituximab and IVIg were administered: renal and liver indexes re‐entered within the ranges, sensorimotor deficits had slow and incomplete remission. In this case, polyneuropathy could be an expression of systemic H.B.V. illness mediated by a specific immunogenic attack in the phase of chronic latent infection, mediated by immune‐complexes precipitation in the reactivation phase, as the renal involvement seems to suggest. The pathological mechanism is under discussion.

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