title: Fatal liver failure due to reactivation of lamivudine-resistant HBV mutant.
abstract: 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 The YMDD motif in the DNA polymerase gene had been replaced by YIDD.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.
authors.affiliation: Department of Internal Medicine, Tokai University School of Medicine, Boseidai, Isehara, Kanagawa 259-1193, Japan. kagawa@is.icc.u-tokai.ac.jp
authors.forename: Tatehiro
authors.initials: T
authors.lastname: Kagawa
authors.forename: Norihito
authors.initials: N
authors.lastname: Watanabe
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kanouda
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takayama
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Shiba
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanai
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kawazoe
authors.forename: Shinji
authors.initials: S
authors.lastname: Takashimizu
authors.forename: Nobue
authors.initials: N
authors.lastname: Kumaki
authors.forename: Kazuo
authors.initials: K
authors.lastname: Shimamura
authors.forename: Shohei
authors.initials: S
authors.lastname: Matsuzaki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mine
mesh_terms: 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*
chemical_list: D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine