[Fatal liver failure after corticosteroid treatment of a hepatitis B virus carrier].
METHODS
A 69-year-old man, a known carrier of hepatitis B virus (HBV) after blood transfusion, developed increasingly severe jaundice with high transaminase levels after receiving steroids in high doses. Significant preceding conditions included chronic obstructive pulmonary disease, coronary heart disease, ulcerative colitis in remission and diabetes mellitus. On admission he was jaundiced and experienced pain on pressure below the right costal margin.


METHODS
Serology demonstrated reactivated hepatitis B with an increase of the HBV-DNA concentration in serum, as well as seroconversion with HBe antigen, anti-HBc-IgM antibodies and absence of anti-HBe antibodies.


METHODS
The history and serological findings indicated reactivation of the hepatitis B by the steroid treatment. Progressive liver failure developed. A marked reduction of virus particles in the blood occurred after a therapeutic trial with the nucleoside analog lamivudine, but the patient died of liver failure 30 days after admission.


CONCLUSIONS
Steroids should be given to known hepatitis B carriers only if strictly indicated, because of the danger of acute deterioration of liver functions by reactivation of the disease with possibly fatal consequences. If steroids are administered, liver functions and serological hepatitis markers should be closely monitored so that any necessary treatment can be quickly initiated.
Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität Regensburg. Angela.Hammond@klinik.uni-regensburg.de
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A
Hammond
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Ramersdorfer
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KD
Palitzsch
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J
Schölmerich
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Lock
D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D000368:Aged; D002353:Carrier State; D017809:Fatal Outcome; D006509:Hepatitis B / Q000188:drug therapy* / Q000201:enzymology / Q000276:immunology; D006510:Hepatitis B Antibodies / Q000097:blood; D006801:Humans; D017093:Liver Failure / Q000139:chemically induced* / Q000201:enzymology / Q000276:immunology; D008297:Male
D000305:Adrenal Cortex Hormones; D006510:Hepatitis B Antibodies
Letales Leberversagen nach Corticosteroidtherapie bei Hepatitis-B-Carrier-Status.