Fatal hepatitis B reactivation treated with entecavir in an isolated anti-HBs positive lymphoma patient: a case report and literature review.
Fatal hepatitis B reactivation treated with entecavir in an isolated anti-HBs positive lymphoma patient: a case report and literature review.
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DOI：
10.4103/1319-3767.98436
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发表时间：
2012-07
期刊：
影响因子：
--
通讯作者：
Campos MJ
中科院分区：
文献类型：
--
作者：
Ferreira R;Carvalheiro J;Torres J;Fernandes A;Giestas S;Mendes S;Agostinho C;Campos MJ
乙肝病毒(乙肝病毒)重新激活是一种公认的并发症，发生在接受化疗的淋巴瘤患者中。仅有极少数单独的抗乙肝表面抗原抗体(抗-HBs)患者的乙肝病毒重新激活的报道。我们报告一例78岁女性，在开始治疗前，被诊断为弥漫性大B细胞性非霍奇金淋巴瘤，仅表现出抗-HBs阳性，作为隐匿性乙肝病毒感染的单一可能标记物。她接受了几种化疗方案(包括利妥昔单抗)治疗疾病复发在3年内。在最后一次化疗后40天，她出现黄疸，血清转氨酶水平显著升高，并出现凝血障碍。乙肝病毒血清学检测HBs Ag、抗-HBc、抗-HBs均为阳性。HBVdna阳性。恩替卡韦的抗病毒治疗立即开始，但患者死于肝功能衰竭。对可检测到抗-HBs水平的患者的乙肝病毒再激活的文献进行了讨论。
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.
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