title: Fatal acute hepatitis B virus infection while receiving immunosuppressants after renal transplantation.
abstract: A 47-year-old man with acute hepatitis B virus (HBV) infection who had been receiving immunosuppressants after renal transplantation developed progressive liver failure. During the clinical course (approximately 7 months), anti-HBc IgM antibody and HBV-DNA polymerase levels remained high, but the serum alanine aminotransferase (ALT) level was consistently less than 150 K.U. Histopathologic examination of the liver showed submassive hepatic necrosis without significant inflammation accompanied by marked fibrosis. Most hepatocytes showed strong nuclear expression of HBc antigen by immunohistochemical staining and electron microscopy revealed numerous intranuclear core-like particles. Hepatitis B virus infection in immunosuppressed individuals occasionally insidiously progresses, resulting in liver failure. The clinical course of such patients thus merits close scrutiny.
authors.affiliation: Second Department of Internal Medicine, Kurume University of Medicine, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Hamada
authors.forename: R
authors.initials: R
authors.lastname: Kumashiro
authors.forename: Y
authors.initials: Y
authors.lastname: Koga
authors.forename: T
authors.initials: T
authors.lastname: Hino
authors.forename: S
authors.initials: S
authors.lastname: Furudera
authors.forename: S
authors.initials: S
authors.lastname: Sakisaka
authors.forename: M
authors.initials: M
authors.lastname: Sata
authors.forename: K
authors.initials: K
authors.lastname: Tanikawa
authors.forename: J
authors.initials: J
authors.lastname: Taguchi
authors.forename: M
authors.initials: M
authors.lastname: Kage
mesh_terms: D000208:Acute Disease; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D017809:Fatal Outcome; D006509:Hepatitis B / Q000150:complications* / Q000276:immunology / Q000473:pathology; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation; D008099:Liver / Q000473:pathology; D017093:Liver Failure / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use; D051437:Renal Insufficiency
chemical_list: D016572:Cyclosporine; D011239:Prednisolone