Skip Navigation
Skip to contents

KMJ : Kosin Medical Journal

OPEN ACCESS
SEARCH
Search
Advanced Search
mobile menu button

Articles

Page Path
HOME > Kosin Med J > Volume 29(2); 2014 > Article
Case Report
A Case of Reactivation of Hepatitis B and Fulminant Hepatitis which developed 3 months following Chemotherapy Including Rituximab in a Patient with Lymphoma
Tae Won Lim1, Hee Taek Oh1, Seung Un Song1, Hae Won Lee1, Ji Yeon Kim1, Seon Ja Park1
Kosin Medical Journal 2014;29(2):161-168.
DOI: https://doi.org/10.7180/kmj.2014.29.2.161
Published online: December 18, 2014

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: December 27, 2013   • Accepted: February 14, 2014

Copyright © 2014 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • 2,452 Views
  • 5 Download
prev
Full Article

Download PDF Download PDF

  • 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
Figure 1A Figure 1B
kmj-29-161f1.jpg
Figure 2
kmj-29-161f2.jpg
Figure 3
kmj-29-161f3.jpg
Table 1.
Serial of Immunologic findings
  8 month ago HDU#1
HBsAg Negative Positive
anti-HBs Negative Negative
HBeAg   Negative
anti-HBe   Negative
IgM anti-HBc   Negative
IgG anti-HBc   Positive
HBV DNA (copies/mL)   4.8 × 108
HAV Ab IgM   Negative
HAV Ab IgG   Positive
ami-HCV Negative Negative

HD; hospital day

Table 2.
Serial of blood chemistry.
  HD#1 HD#2 HD#5 HD#6 HD#7
AST (IU/L) 2461 2345 781 542 262
ALT (IU/L) 2329 2312 1116 895 496
Total bilirubin (mg/dL) 15.0   25.8 28.8 30.7
Direct bilirubin 9.09   11.8 13.5 15.1
gamma GTP (IU/L) 166   107   64
ALP (IU/L) 570   300 295 259
Total protein ig/dL) 5.5   5.7 5.6 5.5
Atbumin 2.9   3.4 32 3.3
PT (sec) 35.6   33.2 40.8 34.8
PT(%) 24   25 20 24
PTINR 3.198   2.85 3.46 2.98
Ammonia 54       269

HD: hospital day

Table 3.
Cases of HBV Reactivation after Treatment including Rituximab in Patients with Lymphoma and HBsAg negative.
Age/ Sex HBV prior to treatment HBV reactivation Onset Cone
HBs Ag HBs Ab HBc DNA HBs Ag HBs Ab HBc DNA
71/F     ND ND + - + + 3 Exp
79/F8 - + + ND + - + + 8 Exp
56/F13 - + + ND - - + + 14 Rcc
69/M23 - + ND ND + -   + 7 Rec
59/M24 - + + ND + - + + 2 Exp
66/F25 - + ND ND + - ND + 2 Rec

This case. ND, not done. HBc, IgG anti-HBc. Onset, Onset months of reactivation after treatment with rituximab. Cone, Conclusion. Rec, Recovered. Exp, Expired.

  • 1.Wands JR, Chura CM, Roll FJ, Maddrey WC. Serial studies of hepatitis-associated antigen and antibody in patients receiving antitumor chemotherapy for myeloproliferative and lymphoproliferative disorders. Gastroenterology 1975;68:105–12.ArticlePubMed
  • 2.Jang JW. Management of Patients with Hepatitis B Virus Infection Who Receive Immunosuppressive Treatment or Chemotherapy. Korean J Med 2012;82:149–58.Article
  • 3.Lim SM, Jang JW, Kim BW, Choi H, Choi KY, Park SJ, et al. Hepatitis B vims reactivation during chlorambucil and prednisolone treatment in an HBsAg-negative and anti-HBs-positive patient with B-cell chronic lymphocytic leukemia. Korean J Hepatol 2008;14:213–8.ArticlePubMed
  • 4.Rehermann B, Ferrari C, Pasquinelli C, Chisari FV. 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 1996;2:1104–8.ArticlePubMed
  • 5.Song SH, Hwang SG. Occult hepatitis B virus infection: transmission and reactivation. Korean J Gastroenterol 2013;62:148–53.ArticlePubMed
  • 6.Kusumoto S, Tanaka Y, Mizokami M, Ueda R. Reactivation of hepatitis B virus following systemic chemotherapy for malignant lymphoma. Int J Hematol 2009;90:13–23.ArticlePubMed
  • 7.Lee KS, Kim DJ. Korean Association for the Study of the Liver Guideline Committee. Management of Chronic Hepatitis B. Korean J Hepatol 2007;13:447–88.ArticlePubMed
  • 8.Chung SM, Sohn JH, Kim TY, Yoo KD, Ahn YW, Bae JH, et al. Fulminant hepatic failure with hepatitis B virus reactivation after rituximab treatment in a patient with resolved hepatitis B. Korean J Gastroenterol 2010;55:266–9.ArticlePubMed
  • 9.Gupta S, Govindarajan S, Fong TL, Redeker AG. Spontaneous reactivation in chronic hepatitis B: patterns and natural history. J Clin Gastroenterol 1990;12:562–8.PubMed
  • 10.Yeo W, Johnson PJ. Diagnosis, prevention and management of hepatitis B virus reactivation during anticancer therapy. Hepatology 2006;43:209–20.ArticlePubMed
  • 11.Park JW, Park KW, Cho SH, Park HS, Lee WJ, Lee DH, et al. Risk of hepatitis B exacerbation is low after transcatheter arterial chemoembolization therapy for patients with HBV-related hepatocellular carcinoma: report of a prospective study. Am J Gastroenterol 2005;100:2194–200.ArticlePubMed
  • 12.Jang JW, Choi JY, Bae SH, Yoon SK, Chang UI, Kim CW, et al. A randomized controlled study of preemptive lamivudine in patients receiving transarterial chemo-lipiodolization. Hepatology 2006;43:233–40.ArticlePubMed
  • 13.Jung HM, Jun DW, Min JY, Doo EY, Nam KW, Kwon YI, et al. A Case of Acute Hepatitis B by Occult HBV Infection without HbsAg Seroconversion. Korean J Med 2012;83:619–23.Article
  • 14.Lau GK. Hepatitis B reactivation after chemotherapy: two decades of clinical research. Hepatol In 2008;2:152–62.Article
  • 15.Kusumoto S, Tanaka Y, Ueda R, Mizokami M. Reactivation of hepatitis B virus following rituximab-plus-steroid combination chemotherapy. J Gastroenterol 2011;46:9–16.ArticlePubMed
  • 16.Lok AS, Liang RH, Chiu EK, Wong KL, Chan TK, Todd D. Reactivation of hepatitis B virus replication in patients receiving cytotoxic therapy. Report of a prospective study. Gastroenterology 1991;100:182–8.ArticlePubMed
  • 17.Lau GK, Yiu HH, Fong DY, Cheng HC, Au WY, Lai LS, et al. Early is superior to deferred preemptive lamivudine therapy for hepatitis B patients undergoing chemotherapy. Gastroenterology 2003;125:1742–9.ArticlePubMed
  • 18.Tur-Kaspa R, Burk RD, Shaul Y, Shafritz DA. Hepatitis B virus DNA contains a glucocorticoid-responsive element. Proc Natl Acad Sci USA 1986;83:1627–31.ArticlePubMedPMC
  • 19.Kawsar HI, Shahnewaz J, Gopalakrishna KV, Spiro TP, Daw HA. Hepatitis B Reactivation in Cancer Patients; Role of Prechemotherapy Screening and Antiviral Prophylaxis. Clin Adv Hematol Oncol 2012;10:370–8.PubMed
  • 20.Yeo W, Chan TC, Leung NW, Lam WY, Mo FK, Chu HL, et al. Hepatitis B virus reactivation in lymphoma patients with prior resolved hepatitis B undergoing anticancer therapy with or without rituximab. J Clin Oncol 2009;27:605–11.ArticlePubMed
  • 21.The Korean Association for the Study of the Liver. Guidelines for Chronic hepatitis B [Internet]. Seoul: The Korean Association for the Study of the Liver; c2011. [cited 2011 DecOl]. Available from: http://www.kasl.org/html/sub05_03_l.asp..
  • 22.Zelenetz Andew D., Gordon Leo I., Wierda William G., Abramson Jeremy S., Advani Ranjana H., Babis Andreadis C., et al. NCCN Clinical Practice Guidelines in Oncology: non-Hodgkin's lymphomas. J Natl Compr Cane Netw. Version 1 2014.
  • 23.Dervite I, Hober D, Morel P. Acute hepatitis B in a patient with antibodies to hepatitis B surface antigen who was receiving rituximab. N Engl J Med 2001;344:68–9.Article
  • 24.Sera T, Hiasa Y, Michitaka K, Konshi I, Masuura K, Tokumoto Y, et al. Anti-HBs-positive liver failure due to hepatitis B virus reactivation induced by rituximab. Intern Med 2006;45:721–4.ArticlePubMed
  • 25.Kim EB, Kim DS, Park SJ, Park Y, Rho KH, Kim SJ. Hepatitis B virus reactivation in a surface antigen-negative and antibody-positive patient after rituximab plus CHOP chemotherapy. Cancer Res Treat 2008;40:36–8.ArticlePubMedPMC

Figure & Data

References

    Citations

    Citations to this article as recorded by  

      • PubReader PubReader
      • Cite
        CITE
        export Copy
        Close
      • Download Citation
        Download Citation
        Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
        Format:
        • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
        • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
        Include:
        • Citation for the content below
        A Case of Reactivation of Hepatitis B and Fulminant Hepatitis which developed 3 months following Chemotherapy Including Rituximab in a Patient with Lymphoma
        Kosin Med J. 2014;29(2):161-168.   Published online December 18, 2014
        DOI: https://doi.org/10.7180/kmj.2014.29.2.161
        Close
      • XML DownloadXML Download
      Figure
      • 0
      • 1
      • 2
      A Case of Reactivation of Hepatitis B and Fulminant Hepatitis which developed 3 months following Chemotherapy Including Rituximab in a Patient with Lymphoma
      Image Image Image
      Figure 1A Figure 1B
      Figure 2
      Figure 3

      Figure 1A Figure 1B

      Figure 2

      Figure 3

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

      Serial of Immunologic findings

        8 month ago HDU#1
      HBsAg Negative Positive
      anti-HBs Negative Negative
      HBeAg   Negative
      anti-HBe   Negative
      IgM anti-HBc   Negative
      IgG anti-HBc   Positive
      HBV DNA (copies/mL)   4.8 × 108
      HAV Ab IgM   Negative
      HAV Ab IgG   Positive
      ami-HCV Negative Negative

      Serial of blood chemistry.

        HD#1 HD#2 HD#5 HD#6 HD#7
      AST (IU/L) 2461 2345 781 542 262
      ALT (IU/L) 2329 2312 1116 895 496
      Total bilirubin (mg/dL) 15.0   25.8 28.8 30.7
      Direct bilirubin 9.09   11.8 13.5 15.1
      gamma GTP (IU/L) 166   107   64
      ALP (IU/L) 570   300 295 259
      Total protein ig/dL) 5.5   5.7 5.6 5.5
      Atbumin 2.9   3.4 32 3.3
      PT (sec) 35.6   33.2 40.8 34.8
      PT(%) 24   25 20 24
      PTINR 3.198   2.85 3.46 2.98
      Ammonia 54       269

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

      Age/ Sex HBV prior to treatment HBV reactivation Onset Cone
      HBs Ag HBs Ab HBc DNA HBs Ag HBs Ab HBc DNA
      71/F     ND ND + - + + 3 Exp
      79/F8 - + + ND + - + + 8 Exp
      56/F13 - + + ND - - + + 14 Rcc
      69/M23 - + ND ND + -   + 7 Rec
      59/M24 - + + ND + - + + 2 Exp
      66/F25 - + ND ND + - ND + 2 Rec
      Table 1. Serial of Immunologic findings

      HD; hospital day

      Table 2. Serial of blood chemistry.

      HD: hospital day

      Table 3. Cases of HBV Reactivation after Treatment including Rituximab in Patients with Lymphoma and HBsAg negative.

      This case. ND, not done. HBc, IgG anti-HBc. Onset, Onset months of reactivation after treatment with rituximab. Cone, Conclusion. Rec, Recovered. Exp, Expired.

      Table 1.

      Table 2.

      Table 3.

      KMJ : Kosin Medical Journal
      © Kosin University College of Medicine.
      TOP