Severe exacerbation of hepatitis after short-term corticosteroid therapy in a patients with "latent" chronic hepatitis B.
We present a case of severe exacerbation of hepatitis after short-term corticosteroid therapy for chronic inflammatory demyelinating polyneuropathy (CIPD) with "latent" chronic hepatitis B showing no HBV-related antigens and antibodies. After corticosteroid pulse therapy for CIPD, the patient had severe exacerbation of hepatitis twice. Although she did not show any hepatitis B virus (HBV)-related antigens or antibodies, sequences of HBV were detected in serum and liver by a nested polymerase chain reaction. A sequence analysis of HBV at the second exacerbation showed that the G-to-A point mutation at nucleotide 1896 that converted codon 28 from tryptophan (TGG) to a stop codon (TAG) in the precore region resulted in amino acid change, which has been frequently observed in fulminant hepatitis and severe hepatitis in Japan.
Shiota
G
G
Second Department of Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan.
Harada
K
K
Oyama
K
K
Udagawa
A
A
Nomi
T
T
Tanaka
K
K
Tsutsumi
A
A
Noguchi
N
N
Kishimoto
Y
Y
Horie
Y
Y
Suou
T
T
Kawasaki
H
H
D000305:Adrenal Cortex Hormones / Q000494:pharmacology / Q000627:therapeutic use*; D000328:Adult; D000954:Antigens, Surface / Q000097:blood / Q000276:immunology; D001483:Base Sequence; D001706:Biopsy; D004279:DNA, Viral / Q000097:blood / Q000235:genetics; D005260:Female; D006515:Hepatitis B virus / Q000187:drug effects / Q000235:genetics / Q000502:physiology; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000473:pathology* / Q000821:virology; D006651:Histocytochemistry; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000473:pathology / Q000821:virology; D008969:Molecular Sequence Data; D017354:Point Mutation / Q000235:genetics; D016133:Polymerase Chain Reaction; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000150:complications* / Q000188:drug therapy*; D017422:Sequence Analysis, DNA; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D000954:Antigens, Surface; D004279:DNA, Viral