Extrahepatic manifestations in children associated with the presence of HBsAg: literature review
DOI:
https://doi.org/10.52556/2587-3873.2025.2(104).14Keywords:
HBsAg, extrahepatic manifestations, childrenAbstract
Hepatitis B virus (HBV) infection remains a major public health concern, including among the pediatric population. Recent studies support the expanded extrahepatic tropism of the virus, with involvement of other organ systems via immune-mediated mechanisms. This article aims to highlight the relationship between hepatitis B surface antigen (HBsAg) positivity and extrahepatic manifestations, in terms of epidemiology, pathogenesis, clinical characteristics, as well as raising awareness regarding the possibility of a previously undiagnosed HBV infection. A systematic review was performed on articles published in the last 10 years across the PubMed, MedLine, NCBI and UpToDate databases. The clinical spectrum of HBV infection is wide, extending from the asymptomatic non-replicative carrier state with detectable HBsAg, through the immunotolerant phase (marked by the presence of viral DNA without liver involvement), to the immunoactive phase, characterized by elevated viral replication, hepatic injury, and a variety of extrahepatic manifestations. These include renal manifestations (membranous glomerulonephritis, IgA nephropathy, membranoproliferative glomerulonephritis, amyloidosis), systemic manifestations (polyarteritis nodosa, cryoglobulinemic vasculitis), hematological manifestations (aplastic anemia, lymphomas), neurological manifestations (Guillain-Barré syndrome, vasculitic neuropathy), cutaneous manifestations (Gianotti-Crosti syndrome, urticaria, lichen planus, vasculitis), and non-rheumatoid arthritis. In children, the most frequently reported extrahepatic manifestations were renal and cutaneous. In conclusion, vaccination and neonatal screening are the pillars of hepatic infection prevention and also indirectly contribute to reducing the incidence of extrahepatic manifestations in the growing child.
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