Subfulminant hepatitis B after infliximab in Crohn's disease: need for HBV-screening?

World J Gastroenterol. 2006 Feb 14;12(6):974-6. doi: 10.3748/wjg.v12.i6.974.


Infections are a major adverse effect during the treatment with anti-TNF-alpha. While exclusion of any bacterial infection and screening for tuberculosis are mandatory before initiating a therapy with anti-TNF-alpha-antibodies, there are no guidelines whether to screen for or how to deal with chronic viral infections such as hepatitis B. In this case report, we have described a patient with Crohn's disease who developed subfulminant hepatitis B after the fourth infusion of infliximab due to an unrecognized HBs-antigen carrier state. He recovered completely after lamivudine therapy was started, but this severe adverse event could have been prevented if screening for HBV and pre-emptive therapy with lamivudine would have been started prior to infliximab. We therefore strongly argue in favor of extended screening recommendations for infectious diseases including viral infections before considering a therapy with infliximab.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Monoclonal / adverse effects
  • Antibodies, Monoclonal / therapeutic use*
  • Crohn Disease / drug therapy*
  • Hepatitis B / diagnosis*
  • Hepatitis B virus / isolation & purification*
  • Humans
  • Infliximab
  • Male
  • Mass Screening
  • Middle Aged


  • Antibodies, Monoclonal
  • Infliximab