Takayasu's arthritis associated with chronic hepatitis B

We report a case with Takayasu's arthritis, which is a unique autoimmune disease of unknown etiology co- existing with chronic hepatitis B. A 26-year old female patient was suffering from dif- fuse myalgia and arthralgia. During her physical exami- nation blood pressures of 100/70 mmHg on her left and 80/40 mmHg on her right arm were measured ; no pal- pable pulses over the brachial, ulnar and radial arteries were present. Bruises were noted over both carotid arter- ies and over the left side of the abdomen. Laboratory tests showed an increased erythrocyte sedimentation rate (ESR) of 120 mm/h and C - reactive protein of 20 mg/L. The diagnosis of Takayasu's arthritis was confirmed by angiography. In the angiography subtotal stenosis of the right carotid artery and a 50% stenosis of the left carotid artery were found. (Corticosteroid therapy of) metyl- prednisolon 8 mg/day was started. After administering the corticosteroid medication, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were ele- vated at levels of 462 IU/l and 324 IU/l respectively. Positive hepatitis B surface antigen (HBsAg), negative hepatitis B early antigen (HBeAg) and hepatitis B core antibody (HBcIgM) were found. 40000 copies/ml HBVDNA was detected. The liver biopsy was graded by Knodell's Histological activity index (HAI) (1) and revealed chronic hepatitis B necroinflammatory activity of 9 and fibroblastic activity of 2. Lamivudine treatment was started with a dosage of 100 mg/day. After six months of treatment HBVDNA was no longer detectable. The patient's vasculitis continued ; she had arthralgia with an increased ESR of 70mm/h and C-reactive protein of 15 mg/L.