HBsAg 음성/anti-HBs 양성인 B세포 만성 림프구백혈병 화자에서 chlorambucil 및 prednisolone 치료 중 재활성화된 B형간염
Hepatitis B virus reactivation during chlorambucil and prednisolone treatment in an HBsAg- negative and anti-HBs-positive patient with B-cell chronic lymphocytic leukemia
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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.
Abstract
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.
참고문헌 (20)
- Rehermann B, "The hepatitis B virus persists for decades after patients' recovery from acute viral hepatitis despite active maintenance of a cytotoxic T-lymphocyte response", Nat Med, 2, pp.1104~1108 (1996)
- Iwai K, "Fulminant hepatitis B following bone marrow transplantation in an HBsAg-negative, HBsAb- positive recipient; reactivation of dormant virus during the immunosuppressive period", Bone Marrow Transplant, 25, pp.105~108 (2000)
- Orlando R, "Severe reactivation of hepatitis B virus infection in a patient with hairy cell leukemia: Should lamivudine prophylaxis be recommended to HBsAg- negative, anti-HBc-positive patients?", Infection, 34, pp.282~284 (2006)
- Sera T, "Anti-HBs-positive liver failure due to hepatitis B virus reactivation induced by rituximab", Intern Med, 45, pp.721~724 (2006)
- Wands JR, "Serial studies of hepatitis-associated antigen and antibody in patients receiving antitumor chemotherapy for myeloproliferative and lymphoproliferative disorders", Gastroenterology, 68, pp.105~112 (1975)
- Lok AS, "Reactivation of hepatitis B virus replication in patients receiving cytotoxic therapy", Gastroenterology, 100, pp.182~188 (1991)
- Yeo W, "Frequency of hepatitis B virus reactivation in cancer patients undergoing cytotoxic chemotherapy: a prospective study of 626 patients with identification of risk factors", J Med Virol, 62, pp.299~307 (2000)
- Yeo W, "Diagnosis, prevention and management of hepatitis B virus reactivation during anticancer therapy", Hepatology, 43, pp.209~220 (2006)
- Kawatani T, "Incidence of hepatitis virus infection and severe liver dysfunction in patients receiving chemotherapy for hematologic malignancies", Eur J Haematol, 67, pp.45~50 (2001)
- Steinberg JL, "Hepatitis B virus reactivation in patients undergoing cytotoxic chemotherapy for solid tumours: precore", core mutations may play an important role, 2000, pp.60, 249~255
- Yeo W, "Hepatitis B virus reactivation in breast cancer patients receiving cytotoxic chemotherapy: a prospective study", J Med Virol, 70, pp.553~561 (2003)
- Lok AS, "Chronic hepatitis B", Hepatology, 45, pp.507~539 (2007)
- Dhedin N, "Reverse seroconversion of hepatitis B after allogeneic bone marrow transplantation: a retrospective study of 37 patients with pretransplant anti-HBs and anti-HBc", Transplantation, 66, pp.616~619 (1998)
- Hui CK, "Kinetics and risk of de novo hepatitis B infection in HBsAg-negative patients undergoing cytotoxic chemotherapy", Gastroenterology, 131, pp.59~68 (2006)
- Torbenson M, "Occult hepatitis B", Lancet Infect Dis, 2, pp.479~486 (2002)
- Awerkiew S, "Reactivation of an occult hepatitis B virus escape mutant in an anti-HBs positive, anti-HBc negative lymphoma patient", J Clin Virol, 38, pp.83~86 (2007)
- Liang R, "Chemotherapy and bone marrow transplantation for cancer patients who are also chronic hepatitis B carriers: a review of the problem", J Clin Oncol, 17, pp.394~398 (1999)
- Lau GK, "Early is superior to deferred preemptive lamivudine therapy for hepatitis B patients undergoing chemotherapy", Gastroenterology, 125, pp.1742~1749 (2003)
- Keeffe EB, "A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: an update", Clin Gastroenterol Hepatol, 4, pp.936~962 (2006)
- Hui CK, "Occult hepatitis B virus infection in hematopoietic stem cell donors in a hepatitis B virus endemic area", J Hepatol, 42, pp.813~819 (2005)