Korean J Hepatol.  2008 Jun;14(2):213-218. 10.3350/kjhep.2008.14.2.213.

Hepatitis B virus reactivation during chlorambucil and prednisolone treatment in an HBsAg-negative and anti-HBs-positive patient with B-cell chronic lymphocytic leukemia

• Lim SM
• Jang JW
• Kim BW
• Choi H
• Choi KY
• Park SJ
• Han CW

• KMID: 760786
• DOI: http://doi.org/10.3350/kjhep.2008.14.2.213

Abstract

It is generally accepted that seroconversion of hepatitis B virus (HBV) surface antigen (HBsAg) to an antibody to HBsAg (anti-HBs) indicates clearance of HBV. Here we report a case of severe hepatitis that manifested during chemotherapy in a female patient with chronic lymphocytic leukemia (CLL) who had been initially seronegative for HBsAg and seropositive for anti-HBs. The patient received chlorambucil and prednisolone for the treatment of CLL. After 6 months the serum levels of aminotransferases were increased, and HBsAg and HBV DNA were present in serum. Lamivudine was administered immediately after confirming the HBV reactivation, which considerably improved jaundice and aminotransferase levels after 3 weeks. The patient was able to resume the chemotherapy whilst continuing lamivudine treatment. This case report highlights the need for physicians to be aware of the potential risk of HBV reactivation even in an HBsAg-negative person but with detectable anti-HBc and/or anti-HBs, underscoring the need for future studies that explore the role of antiviral prophylaxis in this setting.

Keyword

Hepatitis B virus; Reactivation; HBsAg; Chemotherapy

MeSH Terms

Aged
Antineoplastic Combined Chemotherapy Protocols/*therapeutic use
Chlorambucil/*therapeutic use
Female
Hepatitis B/*diagnosis/virology
Hepatitis B Antibodies/*blood/immunology
Hepatitis B Surface Antigens/*blood/immunology
Hepatitis B virus/isolation & purification/physiology
Humans
Leukemia, Lymphocytic, Chronic, B-Cell/complications/*drug therapy
Prednisolone/*therapeutic use
Virus Activation