Uncommon Extrahepatic Manifestations In HBV

Introduction: Hepatitis B surface Antigen (HbsAg) positivity in the general population ranges from 1.1% to 12.2%, with an average prevalence of 3-4%. Based on some regional level studies, it is estimated that in India, approximately 40 million people are chronically infected with Hepatitis B which not only affects liver but has many extrahepatic manifestations like pre-icteric flu-like syndrome with joint pain and rash seen in acute infection. Chronic infection can lead to more serious complications like glomerulonephritis, polyarteritis nodosa, rheumatoid arthritis, sjogren’s syndrome, diabetes mellitus, thyroid disorders, aplastic anemia, lichen planus and malignancies of biliary tract, stomach, and pancreas. Aim of study: To estimate prevalence of Extrahepatic manifestations of Chronic HBV infection in respect to Dermatological, Hematological, Endocrinological and Dental involvement at tertiary care center of Northern India. Material and Methods: This study was conducted at Medical Gastroenterology Department at PGIMS, Rohtak. It was a prospective study done over one year, from 01.11.2024 to 31.10.2025, during which 1000 confirmed hepatitis B patients were evaluated for Dermatological, Hematological, Endocrinological and Dental involvement or problems. All hepatitis B patients were confirmed on HbsAg on Enzyme linked immunosorbent assay (ELISA) test and HBV DNA Quantitative on Polymerase chain reaction test (PCR). Observation and Results: On prospective analysis of 1000 confirmed hepatitis B patients, males were 680 (68%) and females were 320 (32%). Out of total pool of 1000 HBV patients, 81 patients (8.1%) were having dental involvement in form of dry mouth and oral ulcers. Out of these total 81, 43 patients (53.08%) were having dry mouth and 38 patients (46.92%) were having complaints of oral ulcers. In total pool of 1000 HBV patients, 72 patients (7.2%) were diabetics, 20 patients (2%) were having hypothyroidism and 50 patients (5%) were hypertensive. Lichen Planus and aplastic anemia was not seen in any patient. Rheumatoid Factor positivity was seen in 270 patients (27%). Conclusion: The hepatitis B patients need to be evaluated not only from hepatic point of view but also its extra hepatic impact, of which dermatological, hematological, endocrinological, dental and musculoskeletal system are integral part. In Northeren India, as per our observations, rheumatoid factor positivity, dry mouth, oral ulcers and diabetes mellitus are more commonly seen than aplastic anemia or lichen planus which are almost negligible but these findings require confirmation on large scale studies. Keywords: Hepatitis B, Dry mouth, Oral ulcers, Diabetes mellitus, Hypothyroidism, Lichen planus, Aplastic anemia, Rheumatoid Factor