A case of lamivudine-sensitive de novo acute hepatitis B induced by rituximab with the CHOP regimen for diffuse large B cell lymphoma

[Guest guest]

http://www.springerlink.com/content/b806775804043448/

Journal Hepatology International

Publisher Springer New York

ISSN 1936-0533 (Print) 1936-0541 (Online)

Category Case Report

DOI 10.1007/s12072-008-9094-x

Subject Collection Medicine

SpringerLink Date Tuesday, September 23, 2008

PDF (405.7 KB)HTML

Case Report

A case of lamivudine-sensitive de novo acute hepatitis B induced by rituximab

with the CHOP regimen for diffuse large B cell lymphoma

Toru Takahashi1 , Tadashi Koike2, Shigeo Hashimoto3, Tomofumi Miura1, Junichiro

Nakamura1, Satoshi Yamada1, Tsutomu Miura1, Masahiko Yanagi1, Kazuhide

Yamazaki4, Shogo Okoshi4 and Yutaka Aoyagi4

(1) Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital,

2-297-1, Senshu, Nagaoka, Niigata 940-2085, Japan

(2) Division of Blood Transfusion, Nagaoka Red Cross Hospital, 2-297-1, Senshu,

Nagaoka, Niigata 940-2085, Japan

(3) Division of Hematology, Nagaoka Red Cross Hospital, 2-297-1, Senshu,

Nagaoka, Niigata 940-2085, Japan

(4) Division of Gastroenterology and Hepatology, Graduate School of Medical and

Dental Sciences, Niigata University, 1-757, Asahimachidori, Chuoku, Niigata

951-8010, Japan

Received: 27 May 2008 Accepted: 7 August 2008 Published online: 23 September

2008

Abstract A case of de novo acute hepatitis B that showed symptoms of general

malaise and anorexia during rituximab therapy with the CHOP regimen for diffuse

large B cell lymphoma is reported. Lamivudine was strikingly effective, showing

a rapid recovery from liver damage with jaundice. Hepatitis B virus (HBV) DNA in

serum became and stayed undetectable even after the withdrawal of lamivudine,

although HBsAg remained positive over 42 months from the onset. Liver biopsy

showed a picture suggestive of acute viral hepatitis with multinucleated giant

hepatocytes and CD38-positive plasma cell infiltration into liver parenchyma.

Immunohistochemically, CD3-positive T-cells were predominant cells that

infiltrated in liver parenchyma, whereas CD20-positive B cells were essentially

null. Hence, it is suggested from these findings that B lymphocytes might be

crucial for the continuous latency in HBV infection and may give rise to de novo

acute hepatitis B if totally deleted. Moreover, the CHOP regimen might have some

additive effects with the repeated on–off use of corticosteroids to the onset of

the disease. In addition, significance of plasma cell infiltration in this

setting is discussed.