• Pathogenesis of HBV associated PAN is thought to be a combination of deposition of immune complexes in antigen excess
• Goal is to clear immune complexes and suppress viral replication to achieve seroconversion (HBe antigen to HBe antibody), but treatments are limited
• GI related complications highest cause of mortality
• HBV related PAN cases have gone down as a result of safer blood transfusions and mass vaccination campaigns

Case 2

• Strongyloides is a widely prevalent helminthic infection that rarely can lead to a hyperinfection syndrome
• Consider Strongyloides as a cause of upper GI bleeding if diffuse ulceration and friability is present
• Steroids can cause Strongyloides hyperinfection syndrome, which is extremely morbid
• Ensure that patients starting any form of immunosuppression at high-risk of exposure get screened for Strongyloides prior to starting treatment