Clinical expression of 'silent' hepatitis B virus infection in a patient with visceral leishmaniasis.
A 69-year-old male was hospitalized in January 1999 because of visceral leishmaniasis. He had also suffered from anti-hepatitis C virus (HCV)-positive chronic hepatitis for years. All serum hepatitis B virus (HBV) antigens and antibodies were negative except for anti-HBc. The patient was treated with amphotericin B cholesteryl sulfate (2 mg/kg twice a day for 7 days, iv). Fever disappeared on the 3rd day of treatment, the clinical condition improved rapidly and the patient recovered. In May 1999 the patient developed icteric HBsAg-negative acute hepatitis (aspartate aminotransferase 722 U/l; alanine aminotransferase 988 U/l). Anti-HBc IgM was positive and HBV-DNA was detected in serum by PCR. Anti-HAV IgM was negative. A serum sample obtained on presentation and stored at -80 degrees C was retrospectively tested and found positive for HBV-DNA. In July 1999, complete remission of acute hepatitis and seroconversion to anti-HBs was observed. We suppose that a moderate depression of the immune system, probably associated with leishmaniasis, may have enhanced HBV replication in the patient who had an HBsAg-negative 'silent' HBV infection. Restoration of the immune system after successful antiprotozoan therapy might have induced cell-mediated necrosis of the HBV-infected hepatocytes and seroconversion to anti-HBs.
Coppola
N
N
Institute of Infectious Diseases, Second University of Naples, Italy.
Felaco
F M
FM
Sagnelli
E
E
D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D004279:DNA, Viral / Q000032:analysis; D006514:Hepatitis B Surface Antigens / Q000032:analysis*; D019694:Hepatitis B, Chronic / Q000276:immunology / Q000473:pathology*; D022781:Hepatocytes; D006801:Humans; D016867:Immunocompromised Host; D007075:Immunoglobulin M / Q000032:analysis; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000276:immunology; D008297:Male; D009336:Necrosis; D016133:Polymerase Chain Reaction; D012698:Serologic Tests
D000981:Antiprotozoal Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D007075:Immunoglobulin M; D000666:Amphotericin B