title: Chronic graft-versus-host disease complicated by acute hepatitis B.
abstract: We observed a 45-year-old man with acute hepatitis B while receiving treatment of chronic graft-versus-host disease (GVHD) of the liver. When he developed a sudden elevation of serum aminotransferases 17 months after bone marrow transplantation, he was under immunosuppressive therapy consisting of cyclosporin A against chronic GVHD of the liver. Serologic tests for hepatitis B virus (HBV) showed no reactivation but de novo acute infection. The serum levels of aminotransferases after elevation of biliary tract enzymes increased mildly. However, icterus was not observed in his sequential course. A liver biopsy specimen revealed mild acute liver injury accompanied by slight degeneration of bile ducts. It is presumed that owing to immunosuppressive therapy, his liver dysfunction was relatively mild, and the hepatitis became quiescent without becoming serious. On the other hand, the serum of the patient remained hepatitis B surface antigen positive for more than 1 year after the onset of the hepatitis, which suggested chronicity of HBV infection.
authors.affiliation: Department of Medicine, Graduate School of Medicine, Chiba University, Japan.
authors.forename: Tetsuhiro
authors.initials: T
authors.lastname: Chiba
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
authors.forename: Hiroshige
authors.initials: H
authors.lastname: Kojima
authors.forename: Kenichi
authors.initials: K
authors.lastname: Fukai
authors.forename: Fumio
authors.initials: F
authors.lastname: Imazeki
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Saisho
authors.forename: Miki
authors.initials: M
authors.lastname: Nishimura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Saito
mesh_terms: D000208:Acute Disease; D000410:Alanine Transaminase / Q000097:blood / Q000187:drug effects; D001219:Aspartate Aminotransferases / Q000097:blood / Q000187:drug effects; D001652:Bile Ducts / Q000187:drug effects / Q000473:pathology; D001706:Biopsy; D002908:Chronic Disease; D016572:Cyclosporine / Q000009:adverse effects; D006086:Graft vs Host Disease / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D006509:Hepatitis B / Q000097:blood / Q000150:complications*; D006514:Hepatitis B Surface Antigens / Q000097:blood / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008099:Liver / Q000187:drug effects / Q000473:pathology; D008297:Male; D008875:Middle Aged
chemical_list: D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase