[Severe exacerbation of chronic hepatitis B during therapy with corticosteroids and lamivudine therapy and successful short-term combination therapy with interferon-beta and interferon-gamma].
Following an acute episode of undifferentiated collagenosis/autoimmune disease with joint pain, a 50-year-old female patient with known long-standing chronic hepatitis B was treated orally with corticosteroids (30 mg prednisolone in decreasing doses over a period of six months). During this treatment, exacerbation of hepatitis B and massive flare-up under simultaneous treatment with lamivudine occurred (GOT 530 U/L, GPT 791 U/L). Serology was positive for HBs-Ag and anti-HBc-lgM. HBV-DNA titer was > 400,000 copies/ml in polymerase chain reaction. Considering the increased risk of reactivation of autoimmune phenomena during a six months therapy with interferon-alpha, an intensive combination therapy with interferon-beta and -gamma (2 weeks: 1 x 3 MIU nIFN-beta Fiblaferon i.v.; 3 weeks: 1 x 3 MIU nIFN-beta i.v. plus 1 x 50 microg rIFN-gamma Imukine) was carried out over five weeks. After two months this resulted in a complete viral and biochemical response. During an observation period of twelve months no reactivation of the autoimmune disease occurred.
Musch
E
E
Allgemeine Innere Medizin, Marienhospital Bottrop.
Malek
M
M
Chrissafidou
A
A
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D003240:Connective Tissue Diseases / Q000188:drug therapy* / Q000276:immunology; D004359:Drug Therapy, Combination; D005260:Female; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007370:Interferon Type I / Q000627:therapeutic use*; D007371:Interferon-gamma / Q000627:therapeutic use*; D019259:Lamivudine / Q000009:adverse effects* / Q000627:therapeutic use; D008111:Liver Function Tests; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000276:immunology; D008875:Middle Aged; D011239:Prednisolone / Q000009:adverse effects* / Q000627:therapeutic use; D011994:Recombinant Proteins; D012008:Recurrence; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D014775:Virus Activation / Q000187:drug effects
D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D007370:Interferon Type I; D011994:Recombinant Proteins; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D007371:Interferon-gamma; D011239:Prednisolone