Euroasian journal of hepato-gastroenterology

Register      Login

VOLUME 2 , ISSUE 2 ( July-December, 2012 ) > List of Articles

CASE REPORT

A Case of de novo Hepatitis B Complicated due to Lack of Comprehensive Interventional Approach

Masanori Abe, Hiroshi Onji, Youhei Koizumi, Masakazu Hanayama, Morikazu Onji, Masashi Hirooka, Yoshio Tokumoto

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.

DOI: 10.5005/jp-journals-10018-1050

License: CC BY-NC 4.0

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2012; The Author(s).


Abstract

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.


PDF Share
  1. Lee WM. Hepatitis B virus infection. N Engel J Med 1997; 337:1733-45
  2. Reactivation of hepatitis B virus following systemic chemotherapy for malignant lymphoma. Int J Hematol 2009;90:13-23
  3. Anti-HBs-positive liver failure due to hepatitis B virus reactivation induced by rituximab. Inter Med 2006;45:721-24
  4. Severe hepatitis related to chemotherapy in hepatitis B virus carriers with hematologic malignancies. Survey in Japan 1987- 1991. Cancer 1996;78:2210-15
  5. Acute hepatitis B in a patient with antibodies to hepatitis B surface antigen who was receiving rituximab. N Engel J Med 2001;344:68-69
  6. Hepatitis B virus reactivation in lymphoma patients with prior resolved hepatitis B undergoing anticancer therapy with or without rituximab. J Clin Oncol 2009; 27:605-11
  7. Lamivudine for the prevention of hepatitis B virus reactivation in hepatitis B s-antigen seropositive cancer patients undergoing cytotoxic chemotherapy. J Clin Oncol 2004;22:927-34
  8. A revisit of prophylactic lamivudine for chemotherapy-associated hepatitis B reactivation in non-Hodgkin’s lymphoma: A randomized trial. Hepatology 2008;47:844-53
  9. Entecavir resistance is rare in nucleoside naïve patients with hepatitis B. Hepatology 2006;44:1656-65
  10. Prevention of immunosuppressive therapy or chemotherapy-induced reactivation of hepatitis B virus infection. Joint report of the Intractable Liver Disease Study Group of Japan and the Japanese Study of the Standard Antiviral Therapy for Viral Hepatitis. Acta Hepatol Jpn 2009;50:38-42
  11. Prevention of hepatitis B virus reactivation in patients receiving immunosuppressive therapy or chemotherapy. Heptol Res 2012;42:627-36. Figs 2A and B: Biopsy specimen on the 63rd clinical day. Livercell damage, cell death and inflammatory cells infiltration were seen predominantly in central area, but there was no bridging necrosis. These findings indicate resolved acute hepatitis A B A Case of de novo Hepatitis B Complicated due to Lack of Comprehensive Interventional Approach Euroasian Journal of Hepato-Gastroenterology, July-December 2012;2(2):122-125 125 EJOHG 12. European Association for the Study of the Liver. EASL clinical practice guidelines: Management of chronic hepatitis B. J Hepatol 2009;50:227-42
  12. Reactivation of hepatitis B during immunosuppressive therapy: Potentially fatal yet preventable. Ann Int Med 2012;156:743-45
  13. Hepatitis B virus reactivation following immunosuppressive therapy: Guidelines for prevention and management. Internal Med J 2007;37:705-12
  14. Prevalence of reactivation of hepatitis B virus replication in rheumatoid arthritis patients. Mod Rheumatol 2011;21:16-23.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.