Fatal liver failure due to reactivation of lamivudine-resistant HBV mutant.

Abstract

We report a case of fatal liver failure due to reactivation of lamivudine-resistant HBV. A 53-year-old man was followed since 1998 for HBV-related chronic hepatitis. Serum HBV-DNA was 150 MEq/mL (branched DNA signal amplification assay) and ALT levels fluctuated between 50-200 IU/L with no clinical signs of liver cirrhosis. Lamivudine (100 mg/d) was started in May 2001 and serum HBV-DNA subsequently decreased below undetectable levels. In May 2002, serum HBV-DNA had increased to 410 MEq/mL, along with ALT flare (226 IU/L). The YMDD motif in the DNA polymerase gene had been replaced by YIDD. Lamivudine was continued and ALT spontaneously decreased to the former levels. On Oct 3 the patient presenting with general fatigue, nausea and jaundice was admitted to our hospital. The laboratory data revealed HBV reactivation and liver failure (ALT: 1828 IU/L, total bilirubin: 10 mg/dL, and prothrombin INR: 3.24). For religious reasons, the patient and his family refused blood transfusion, plasma exchange and liver transplantation. The patient died 10 d after admission. The autopsy revealed remarkable liver atrophy.

• Authors: Tatehiro Kagawa, Norihito Watanabe, Hisashi Kanouda, Ichiro Takayama, Tadahiko Shiba, Takashi Kanai, Kazuya Kawazoe, Shinji Takashimizu, Nobue Kumaki, Kazuo Shimamura, Shohei Matsuzaki, Tetsuya Mine
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 10 Issue 11 Pg. 1686-7 (Jun 01 2004) ISSN: 1007-9327 [Print] United States
• PMID: 15162553 (Publication Type: Case Reports, Journal Article)

Chemical References

• Reverse Transcriptase Inhibitors
• Lamivudine

Topics

• Drug Resistance, Viral (genetics)
• Fatal Outcome
• Hepatitis B virus (drug effects, genetics)
• Hepatitis B, Chronic (drug therapy, pathology, virology)
• Humans
• Lamivudine (therapeutic use)
• Male
• Middle Aged
• Mutation
• Recurrence
• Reverse Transcriptase Inhibitors (therapeutic use)