[Impending liver failure after chemoimmunotherapy-induced reactivation of hepatitis B - successful treatment with entecavir].

Abstract

HISTORY AND CLINICAL FINDINGS:

An 83-year old woman had been treated with bendamustin and rituximab for prolymphocytic leukemia. Two weeks after cycle 6 of chemotherapy, signs and symptoms of a severe hepatitis occurred.

INVESTIGATIONS:

Highly elevated values for AST (1353 U/l) and bilirubin (27.8 mg/dl), impaired coagulation parameters (INR 1,68) and the detection of ascites led to the diagnosis of an impending liver failure induced by reactivation of a hitherto unknown hepatitis B (HBs antigen pos., HBe antigen pos., anti HBc IgG pos., HBV DNA 1,65 Mio copies/ml).

TREATMENT AND COURSE:

After an immediately started treatment with entecavir (0.5 mg/d po), symptoms and laboratory parameters rapidly improved. 4 months later liver chemistry was completely normal and HBV DNA was negative. After 8 months, a seroconversion to anti HBs was noted.

CONCLUSION:

In single cases, life threatening complications of chemotherapy induced reactivation of hepatitis B may be successfully treated by potent and stabile nucleosidanalogs.

• Authors: G Lock, F Helmich, M Bertram
• Journal: Deutsche medizinische Wochenschrift (1946) (Dtsch Med Wochenschr) Vol. 137 Issue 23 Pg. 1248-50 (Jun 2012) ISSN: 1439-4413 [Electronic] Germany
• Vernacular Title: Drohendes Leberversagen nach Chemoimmuntherapie-induzierter Reaktivierung einer Hepatitis B - erfolgreiche Therapie mit Entecavir.
• PMID: 22644491 (Publication Type: Case Reports, English Abstract, Journal Article)
• Copyright: © Georg Thieme Verlag KG Stuttgart · New York.

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Antiviral Agents
• Nitrogen Mustard Compounds
• Rituximab
• entecavir
• Guanine
• Bendamustine Hydrochloride

Topics

• Aged, 80 and over
• Antibodies, Monoclonal, Murine-Derived (administration & dosage, adverse effects)
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Antiviral Agents (therapeutic use)
• Bendamustine Hydrochloride
• Diagnosis, Differential
• Female
• Guanine (analogs & derivatives, therapeutic use)
• Hepatitis B (chemically induced, diagnosis, drug therapy)
• Hepatitis B virus (drug effects, physiology)
• Humans
• Immunocompetence (drug effects)
• Leukemia, Prolymphocytic (drug therapy)
• Liver Failure (chemically induced, diagnosis, drug therapy)
• Liver Function Tests
• Nitrogen Mustard Compounds (administration & dosage, adverse effects)
• Rituximab
• Virus Activation (drug effects)