Hepatic failure due to fibrosing cholestatic hepatitis in a patient with pre-surface mutant hepatitis B virus and mixed connective tissue disease treated with prednisolone and chloroquine.
Fibrosing cholestatic hepatitis (FCH) is a severe variant of hepatitis B infection that has until recently been described almost exclusively in the setting of organ transplantation and HIV infection. This case report describes a patient with pre-surface (pre-S) mutant hepatitis B virus (HBV) infection who developed a fatal form of FCH after high dose prednisolone for mixed connective tissue disease (MCTD). The role of corticosteroids and pre-S viral mutation in the pathogenesis of the disease is discussed, and the importance of early diagnosis is emphasised. This report alerts the physician to the need for close monitoring of LFTs and HBV DNA of hepatitis B carriers during immunosuppressive therapy regardless of the indication. As in the transplantation setting, viral DNA levels should be kept to undetectable if viral replication or recurrence is to be prevented.
Department of Gastroenterology and Hepatology, The Alfred Hospital, Commercial Road, Prahran, Vic. 3181, Australia.
Simon A
SA
Zanati
Stephen A
SA
Locarnini
John P
JP
Dowling
Peter W
PW
Angus
Francis J
FJ
Dudley
Stuart K
SK
Roberts
D000328:Adult; D002738:Chloroquine / Q000009:adverse effects* / Q000627:therapeutic use; D002779:Cholestasis / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D006509:Hepatitis B / Q000150:complications / Q000473:pathology / Q000821:virology*; D006514:Hepatitis B Surface Antigens / Q000235:genetics; D006515:Hepatitis B virus / Q000235:genetics*; D006801:Humans; D007165:Immunosuppression Therapy; D008099:Liver / Q000473:pathology; D017093:Liver Failure / Q000209:etiology*; D008947:Mixed Connective Tissue Disease / Q000150:complications* / Q000188:drug therapy; D009154:Mutation; D011239:Prednisolone / Q000009:adverse effects* / Q000627:therapeutic use
D006514:Hepatitis B Surface Antigens; D002738:Chloroquine; D011239:Prednisolone