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March 29, 1976

Digital Vasospasm and Infarction Associated With Hepatitis B Antigenemia

Author Affiliations

From the Rheumatology Service, Department of Medicine, Brooke Army Medical Center, San Antonio, Tex. Dr Arnold is now with the University of Illinois at the Medical Center, Chicago.

JAMA. 1976;235(13):1362-1363. doi:10.1001/jama.1976.03260390048032

THE EXTRAHEPATIC manifestations of hepatitis B, many the result of immune complex disease, have been appreciated only in recent years. These manifestations can be grouped into two syndromes: (1) a transient, serum sickness-like illness, consisting primarily of polyarthritis and an urticarial or exanthematous skin rash,1,2 and (2) periarteritis nodosa, with fever, skin rash, renal failure, hypertension, and central nervous system disease, which is associated with a persistent hepatitis B antigenemia and frequently proves fatal.3-6 In addition, two cases of glomerulonephritis secondary to hepatitis B antigenemia with glomerular immune complex deposition have been reported.7,8 We report a patient with hepatitis B antigenemia who had a serum sickness-like syndrome associated with digital vasospasm, striking cyanosis, and subsequent infarction of her fingertips one month before manifesting icteric hepatitis.

Report of a Case  A 27-year-old woman was well until eight days prior to admission, when she complained of slight fever and