Fatal hepatitis B reactivation treated with entecavir in an isolated anti-HBs positive lymphoma patient: a case report and literature review

Saudi J Gastroenterol. Jul-Aug 2012;18(4):277-81. doi: 10.4103/1319-3767.98436.

Abstract

Hepatitis B virus (HBV) reactivation is a well-recognized complication that occurs in lymphoma patients who undergo chemotherapy. Only very few cases of HBV reactivation in patients with isolated antibody against hepatitis B surface antigen (anti-HBs) have been reported. We present a case of a 78-year-old woman diagnosed with diffuse large B cell non-Hodgkin's lymphoma who only displayed a positive anti-HBs, as the single possible marker of occult HBV infection, before starting therapy. She was treated with several chemotherapeutic regimens (including rituximab) for disease relapses during 3 years. Forty days after the last cycle of chemotherapy, she presented with jaundice, markedly elevated serum aminotransferase levels, and coagulopathy. HBV serology showed positivity for HBsAg, anti-HBc and anti-HBs. HBV DNA was positive. Antiviral treatment with entecavir was promptly initiated, but the patient died from liver failure. A review of the literature of HBV reactivation in patients with detectable anti-HBs levels is discussed.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Antibodies, Monoclonal, Murine-Derived / therapeutic use
  • Antineoplastic Agents / therapeutic use
  • Antiviral Agents / therapeutic use*
  • Fatal Outcome
  • Female
  • Guanine / analogs & derivatives*
  • Guanine / therapeutic use
  • Hepatitis B / diagnosis
  • Hepatitis B / drug therapy
  • Hepatitis B / etiology*
  • Hepatitis B Antibodies / blood
  • Hepatitis B virus / physiology*
  • Humans
  • Lymphoma, Large B-Cell, Diffuse / drug therapy
  • Lymphoma, Large B-Cell, Diffuse / pathology
  • Lymphoma, Large B-Cell, Diffuse / virology*
  • Rituximab
  • Virus Activation*

Substances

  • Antibodies, Monoclonal, Murine-Derived
  • Antineoplastic Agents
  • Antiviral Agents
  • Hepatitis B Antibodies
  • Rituximab
  • entecavir
  • Guanine