%0 Journal Article
%T The Efficacy of Mizoribine (Inosine Monophosphate Dehydrogenase Inhibitor) for ANCA-Associated Vasculitis with Hepatitis B Virus Carrier
%A Jun Muratsu
%A Atsuyuki Morishima
%A Masayoshi Kukida
%A Anzu Tanaka
%A Shigeki Fujita
%A Katsuhiko Sakaguchi
%J Case Reports in Immunology
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/929318
%X A 42-year-old female who was an asymptomatic carrier of hepatitis B virus (HBV) was diagnosed with antineutrophil cytoplasm antibody- (ANCA-) associated vasculitis and was induced to remission with 30£¿mg/day prednisolone nine years ago. Four years ago, she suffered recurrence of ANCA-associated vasculitis and with 30£¿mg/day prednisolone was induced to remission. This time, laboratory data showed 3-fold increase in myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) levels. Administration of 30£¿mg/day prednisolone was started. Three days later, she was admitted to our hospital suffering from fatigue. After admission, urinalysis showed glomerular hematuria. Despite administration of 30£¿mg/day prednisolone, MPO-ANCA titer had been of high level, ranging from 42 to 83 EU for 2.5 months. Furthermore, the adverse effects of steroid were seen. We decided the tapering of prednisolone (25£¿mg/day) and the start of mizoribine (4-carbamoyl-1-¦Â-D-ribofuranosyl imidazolium-5-olate) administration. After mizoribine treatment, MPO-ANCA titer was decreased without any mizoribine-related adverse effects. Six months later, MPO-ANCA titer was decreased to normal levels and she was induced to clinical remission without reactivation of HBV. We describe the effectiveness of mizoribine for the ANCA-associated vasculitis complicated with HBV-carrier. 1. Introduction The common treatment for antineutrophil cytoplasm antibody- (ANCA-) associated vasculitis is oral cyclophosphamide-corticosteroid combination therapy. However, there are some reports that cyclophosphamide-corticosteroid combination therapy has serious complications such as increased risk of infection, leucopenia, osteoporosis, diabetes, and sterility and malignancy [1¨C4]. Reactivation of hepatitis B virus (HBV) replication is one of complications in patients with chronic HBV infection who receive immunosuppressive therapy [5]. Mizoribine (4-carbamoyl-1-¦Â-D-ribofuranosyl imidazololium-5-olate), a purine synthesis inhibitor, has an immunosuppressive effect equivalent to that of azathioprine, but with less hepatic toxicity and myelosuppression [6]. Mizoribine and mycophenolic acid inhibit the rate-limiting enzyme inosine monophosphate dehydrogenase (IMPDH) in the de novo pathway of purine biosynthesis. It was reported that IMPDH inhibitors have potential antiviral effect in vitro and inhibited HBV replication with cultures of primary human hepatocytes, HepG2 2.2.15 cells [7¨C12]. There have been some reports that mizoribine is useful not only as a preemptive treatment to prevent relapse, but as also an
%U http://www.hindawi.com/journals/crii/2012/929318/