title: Repeated jaundice due to YMDD mutant in a patient with prolonged lamivudine therapy for chronic hepatitis B under prednisolone treatment for Still's disease.
abstract: A 50-year-old woman patient began receiving lamivudine because of acute exacerbation of chronic hepatitis B. She also suffered from adult-onset Still's disease and had received prednisolone for 5 years. Lamivudine was effective for treatment of the first flare. Fifteen months after lamivudine treatment was started, a breakthrough due to lamivudine-resistant strain M5521 occurred. Between 10 and 12 months after the breakthrough, flare with jaundice occurred 3 times. We decided interferon would not be suitable, because it could induce activation of Still's disease. Prolonged lamivudine therapy is only recommended in cases of hepatitis B in which there is no alternative treatment.
mesh_terms: D000595:Amino Acid Sequence; D004279:DNA, Viral / Q000032:analysis; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000821:virology; D006518:Hepatitis Viruses / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D007565:Jaundice / Q000209:etiology*; D019259:Lamivudine / Q000627:therapeutic use*; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation / Q000235:genetics; D016133:Polymerase Chain Reaction; D011239:Prednisolone / Q000627:therapeutic use; D012008:Recurrence; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D017422:Sequence Analysis, DNA; D016706:Still's Disease, Adult-Onset / Q000188:drug therapy*; D014779:Virus Replication / Q000187:drug effects
chemical_list: D004279:DNA, Viral; D005938:Glucocorticoids; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D011239:Prednisolone