Abstract Introduction- Cutaneous polyarteritis nodosa (cPAN) is a rare, chronic, relapsing vasculitis limited to medium-sized vessels of the skin. Hepatitis B virus (HBV) is a known etiological factor in systemic PAN; however, its association with cPAN is less commonly reported. It triggers symptoms like fatigue, fever, joint pain, abdominal pain, and skin lesions caused by immune complex deposition. HBV-PAN is an immune-complex-mediated disease where viral antigens form complexes that deposit in blood vessels, causing inflammation, thrombosis, and microaneurysms, particularly in the kidneys, skin, and gastrointestinal tract. Case Report- A 43-year-old female, not a known case of any chronic illness presented with arthralgia for last fifteen years and recurrent painful nodular and ulcerative lesions over the lower limbs for last four years. The last crop of these lesions occurred four months back. The lesions followed a characteristic progression from nodules to purpura, livedo reticularis, and ulceration, healing with scarring. On detailed laboratory investigations revealed elevated inflammatory markers and active Hepatitis B infection. Autoimmune workup was negative. Skin biopsy demonstrated necrotizing medium-vessel vasculitis. The patient was treated with corticosteroids and antiviral therapy, resulting in significant clinical improvement. Conclusion- Hepatitis B is usually associated with systemic PAN and association with cutaneous PAN is rare. This case highlights the classical relapsing course of cutaneous PAN and emphasizes the importance of screening for Hepatitis B in patients presenting with cutaneous vasculitis. The scientific rationale-based treatment with antiviral and immunosuppressives led to fruitful outcome. Keywords- Polyarteritis nodosa, Hepatitis B, Ulcer, Purpura, Livedo reticularis
Gupta et al. (Mon,) studied this question.