A possible misdiagnosis in patients presenting with acute HBsAg-negative hepatitis: the role of hepatitis delta virus.
We describe here two cases of delta hepatitis (a coinfection and a superinfection) presenting as acute HBsAg-negative hepatitis. The first patient, a parenteral drug abuser, had a biphasic course of the disease, with HBsAg detectable transiently only during the relapse. Testing for delta markers on stored sera gave evidence of HBV/HDV coinfection. The other patient, a hospital nurse, chronic asymptomatic carrier of HBsAg, developed fulminant hepatitis with the transient appearance of antibody to HBsAg. She survived massive liver necrosis, and serological analysis of HDV markers documented a hepatitis delta virus superinfection. These cases demonstrate the possible substantial repression of HBV gene products exerted by the replication of delta virus, with a likely misdiagnosis if delta markers are not determined in serial serum samples.
Caredda
F
F
Institute of Internal Medicine, University of Milan, L. Sacco Hospital, Grassi.
Antinori
S
S
Pastecchia
C
C
Coppin
P
P
Arici
C
C
Fracassetti
O
O
D000208:Acute Disease; D000328:Adult; D000956:Antigens, Viral / Q000032:analysis; D002353:Carrier State / Q000276:immunology; D003951:Diagnostic Errors; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D006510:Hepatitis B Antibodies / Q000032:analysis; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D003699:Hepatitis D / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D003698:Hepatitis Delta Virus / Q000276:immunology; D035923:Hepatitis delta Antigens; D006801:Humans; D008297:Male; D015163:Superinfection
D000956:Antigens, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D035923:Hepatitis delta Antigens; C442244:hepatitis delta virus large antigen