Citation Information :
Abe M, Onji H, Koizumi Y, Hanayama M, Onji M, Hirooka M, Tokumoto Y. A Case of de novo Hepatitis B Complicated due to Lack of Comprehensive Interventional Approach. Euroasian J Hepatogastroenterol 2012; 2 (2):122-125.
Here, we report a case of de novo type B hepatitis in a patient
with hepatitis B surface antigen (HBsAg) negative but positive
for low titer of anti-HBc antibody (anti-HBc titer; dilution 200;
negative). As the disease was anticipated in advance, the patient
received nucleos(t)ide analogs, but de novo type B hepatitis
was developed, because of discontinuation of antiviral drugs.
A 59-year-old male with a history of T cell rich diffuse large Bcell
lymphoma (DLBCL) and was treated with rituximab plus
cyclophosphomide, doxorubicin, vincristine and prednisolone
(R-CHOP). The patient responded to anticancer therapy and
his complete responder status was confirmed by PET-CT on
October 4, 2010. As the patient was expressing low levels of
anti-HBc (anti-HBc titer; dilution 200-negative), he was given
lamivudine to block HBV reactivation, but the drug was continued
after 1 year due to apparent improvement. Stoppage of antiviral
drug resulted in detectable HBV DNA and evidences of liver
damages and he was referred to our department for specialized
consultation about liver-related complications. He was given
entecavir at a dose of 1 gm/day from May 2012. However, the
parameters of liver function test showed anomaly indicating
progressive liver damages. Subsequently, he was given steroid
pulse therapy with 1,000 mg of prednisolone and tapered
successively. The levels of HBV DNA decreased and parameters
of liver function test were improved. A biopsy specimen taken
in July 2012 showed the findings compatible with resolved acute
hepatitis. To prevent de novo type B hepatitis, critical observation
and timely management of the patients are necessary. The
administration with nucleoside analogs at least 1 year after
R-CHOP therapy is recommended in guideline of Japanese
Society of Hepatology. However, we should reconsider the term
of administration with nucleoside analogs after R-CHOP therapy.
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