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

[Guest guest]

[Hepatitis B virus reactivation during chlorambucil and prednisolone treatment

in an HBsAg-negative and anti-HBs-positive patient with B-cell chronic

lymphocytic leukemia.]

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

Korean J Hepatol, June 1, 2008; 14(2): 213-8.

Department of Internal Medicine, The Catholic University of Korea, College of

Medicine, Incheon, Korea.

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.

PMID: 18617769