Abstract: PUB220
Successful Antiviral Treatment of Hepatitis C Virus-Associated Polyarteritis Nodosa with Resolution of Dialysis-Dependent Kidney Failure
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Killen, John P., Macquarie University, Sydney, New South Wales, Australia
- Teh, Tobias T K, Macquarie University, Sydney, New South Wales, Australia
- Buckley, Niamh S, Northern Beaches Hospital, Frenchs Forest, New South Wales, Australia
- Nguyen, Huu Matthew, Northern Beaches Hospital, Frenchs Forest, New South Wales, Australia
Introduction
Hepatitis C virus (HCV)-associated polyarteritis nodosa (PAN) is a rare disease with no standardised treatment. We report a case of HCV-associated PAN requiring hemodialysis (HD) responding to glecaprevir + pibrentasvir antiviral therapy resulting in successful subsequent HD independence.
Case Description
A 63-year-old man with a history of intravenous drug use, known chronic HCV infection (genotype 3a), previous hepatitis B virus (HBV) exposure, chronic venous insufficiency, and hypertension, presented with painful non-healing bilateral lower limb ulcers worsening over the previous year.
In 2013 he had a kidney biopsy that reported acute tubular necrosis with no evidence of vasculitis or cryoglobulins. Acute cryoglobulinemic vasculitis secondary to HCV (viral load 1,135,800 IU/mL) was considered but cryoglobulins were repeatedly negative.
On this presentation he had deteriorating kidney function with creatinine 417 µmol/L and eGFR 9. Serologies were RF positive, low C4 and normal C3, with HCV RNA detected (989,000 IU/mL), HBV cAb (+) and HBV sAb (+), and negative for HIV, ANA, P-ANCA, C-ANCA, ds-DNA, lupus anticoagulant, anti-GBM, cardiolipin, B2GP1, and cryoglobulins were again negative. A second kidney biopsy showed small-to-medium interlobular arteries that displayed florid vasculitis with mixed inflammatory infiltrate and fibrinoid necrosis on a background of predominantly sclerosed glomeruli consistent with HCV-associated PAN. Thrice weekly HD was commenced, 60 mg prednisolone daily with gradual weaning, glecaprevir + pibrentasvir thrice daily for 23 weeks, and entecavir 0.5 mg once weekly for prevention of HBV reactivation. HD sessions reduced to twice weekly, then once weekly, and ultimately the patient successfully discontinued HD after 314 days on HD. The ulcers progressively healed, with the vasculitis staying in remission whilst remaining off immunosuppression.
Discussion
This is the first report of HCV-associated PAN requiring dialysis treated with glecaprevir + pibrentasvir that was able to successfully discontinue HD and achieve vasculitis remission following complete resolution of HCV viremia. The patient now has stage 3 CKD and remains on a SGLT2 inhibitor.