Fatal hepatitis B reactivation treated with entecavir in an isolated anti-HBs positive lymphoma patient: a case report and literature review.

Abstract

Hepatitis B virus (HBV) reactivation is a well-recognized complication that occurs in lymphoma patients who undergo chemotherapy. Only very few cases of HBV reactivation in patients with isolated antibody against hepatitis B surface antigen (anti-HBs) have been reported. We present a case of a 78-year-old woman diagnosed with diffuse large B cell non-Hodgkin's lymphoma who only displayed a positive anti-HBs, as the single possible marker of occult HBV infection, before starting therapy. She was treated with several chemotherapeutic regimens (including rituximab) for disease relapses during 3 years. Forty days after the last cycle of chemotherapy, she presented with jaundice, markedly elevated serum aminotransferase levels, and coagulopathy. HBV serology showed positivity for HBsAg, anti-HBc and anti-HBs. HBV DNA was positive. Antiviral treatment with entecavir was promptly initiated, but the patient died from liver failure. A review of the literature of HBV reactivation in patients with detectable anti-HBs levels is discussed.

• Authors: Rosa Ferreira, Joana Carvalheiro, Joana Torres, Alexandra Fernandes, Sílvia Giestas, Sofia Mendes, Cláudia Agostinho, Mário J Campos
• Journal: Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association (Saudi J Gastroenterol) 2012 Jul-Aug Vol. 18 Issue 4 Pg. 277-81 ISSN: 1998-4049 [Electronic] India
• PMID: 22824772 (Publication Type: Case Reports, Journal Article, Review)

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Antineoplastic Agents
• Antiviral Agents
• Hepatitis B Antibodies
• Rituximab
• entecavir
• Guanine

Topics

• Aged
• Antibodies, Monoclonal, Murine-Derived (therapeutic use)
• Antineoplastic Agents (therapeutic use)
• Antiviral Agents (therapeutic use)
• Fatal Outcome
• Female
• Guanine (analogs & derivatives, therapeutic use)
• Hepatitis B (diagnosis, drug therapy, etiology)
• Hepatitis B Antibodies (blood)
• Hepatitis B virus (physiology)
• Humans
• Lymphoma, Large B-Cell, Diffuse (drug therapy, pathology, virology)
• Rituximab
• Virus Activation