A Case of Reactivation of Hepatitis B and Fulminant Hepatitis which developed 3 months following Chemotherapy Including Rituximab in a Patient with Lymphoma

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Kosin Med J. 2014;29(2):161-168

Publication date (electronic) : 2014 December 18

doi : https://doi.org/10.7180/kmj.2014.29.2.161

Tae Won Lim ¹, Hee Taek Oh ¹^,, Seung Un Song ¹, Hae Won Lee ¹, Ji Yeon Kim ¹, Seon Ja Park ¹

¹Department of Gastroenterology, Dae-Dong Hospital, Busan, Korea

Corresponding Author : Tae Won Lim, Department of Internal Medicine, Dae-Dong Hospital, 187, Chungyeldae-ro, Dongrae-gu, Busan, 607-711, Korea TEL: +82-51-550-9615 FAX: +82-51-553-7575 E-mail: twoni@hanmail.net

Received 2013 December 27; 2013 December 27; Accepted 2014 February 14.

Abstract

Since Wands et al. reported for the first time in 1975 the reactivation of the hepatitis B virus in hematologic disease patients who had been receiving chemotherapy, the efficacy of chemotherapy and immunosuppressants has improved. As a result, the frequency of the reactivation of hepatitis B is increasing. Reported herein is a case of a non-Hodgkin lymphoma patient in her 70s who was suspected to have had HBsAg negative/anti-HBs negative occult HBV infection. The patient experienced fulminant hepatitis caused by the reactivation of hepatitis B, and died three months after the R-CHOP regimen was completed. In the HBsAg negative plus HBV DNA-negative case, there were few instances of viral activation of HBV. In this case, antiviral therapy was needed when the patient was confirmed to have become HBV DNA positive through regular monitoring, but its necessity is often overlooked, unlike the preemptive antiviral treatment in the HBsAg positive cases.

Keywords: Chemotherapy; Hepatitis B virus; Immunosuppression

Serial of Immunologic findings

Table 2.

Serial of blood chemistry.

Table 3.

Cases of HBV Reactivation after Treatment including Rituximab in Patients with Lymphoma and HBsAg negative.

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