Fatal liver failure due to reactivation of lamivudine-resistant HBV mutant.
We report a case of fatal liver failure due to reactivation of lamivudine-resistant HBV. A 53-year-old man was followed since 1998 for HBV-related chronic hepatitis. Serum HBV-DNA was 150 MEq/mL (branched DNA signal amplification assay) and ALT levels fluctuated between 50-200 IU/L with no clinical signs of liver cirrhosis. Lamivudine (100 mg/d) was started in May 2001 and serum HBV-DNA subsequently decreased below undetectable levels. In May 2002, serum HBV-DNA had increased to 410 MEq/mL, along with ALT flare (226 IU/L). The YMDD motif in the DNA polymerase gene had been replaced by YIDD. Lamivudine was continued and ALT spontaneously decreased to the former levels. On Oct 3 the patient presenting with general fatigue, nausea and jaundice was admitted to our hospital. The laboratory data revealed HBV reactivation and liver failure (ALT: 1828 IU/L, total bilirubin: 10 mg/dL, and prothrombin INR: 3.24). For religious reasons, the patient and his family refused blood transfusion, plasma exchange and liver transplantation. The patient died 10 d after admission. The autopsy revealed remarkable liver atrophy.
Kagawa
Tatehiro
T
Department of Internal Medicine, Tokai University School of Medicine, Boseidai, Isehara, Kanagawa 259-1193, Japan. kagawa@is.icc.u-tokai.ac.jp
Watanabe
Norihito
N
Kanouda
Hisashi
H
Takayama
Ichiro
I
Shiba
Tadahiko
T
Kanai
Takashi
T
Kawazoe
Kazuya
K
Takashimizu
Shinji
S
Kumaki
Nobue
N
Shimamura
Kazuo
K
Matsuzaki
Shohei
S
Mine
Tetsuya
T
D024882:Drug Resistance, Viral / Q000235:genetics; D017809:Fatal Outcome; D006515:Hepatitis B virus / Q000187:drug effects* / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D012008:Recurrence; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*
D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine