Recurrent demyelinating transverse myelitis in a high titer HBs-antigen carrier

A 46-year-old man who was an extremely high titer hepatitis B surface (HBs)-antigen carrier had three attacks of acute demyelinating transverse myelitis associated with signs of meningeal irritation. Each episode showed good response to corticosteroid therapy. The cerebrospinal fluid was characterized by elevated levels of myelin basic protein (MBP) and predominating CD4(+)CD29(+) helper-inducer T cells during the acute stages, and also by persistently positive HBs antigen. There were neither autoantibodies nor evidence of vasculitis. However, circulating immune complexes composed of HBs antigen disappeared after treatment, indicating that immunity to hepatitis B virus played a role in the demyelinative lesion formation in the central nervous system (CNS). In light of the animal studies demonstrating autoimmunity triggered by molecular mimicry between MBP and hepatitis B virus antigens, this patient may serve as a rare example of CNS demyelination in humans with the same autoimmune etiology.