HBV reactivation with fatal fulminating hepatitis during rituximab treatment in a subject negative for HBsAg and positive for HBsAb and HBcAb.
A 51-year-old man who was hepatitis B surface antigen (HBsAg)-negative and positive for anti-hepatitis B surface antigen (anti-HBs) and anti-hepatitis B core antigen (anti-HBc), during rituximab therapy for chronic Lymphocytic leukemia, developed reactivation of hepatitis B virus (HBV) infection with hepatitis that proceeded towards hepatic failure and death in spite of lamivudine therapy. HBsAg remained persistently negative, notwithstanding a high HBV-DNA titer. Our observation, following other cases of fatal reactivation of HBV infection in patients receiving rituximab, suggests that, in all patients with previous markers of HBV infection, lamivudine prophylaxis should be considered during rituximab therapy.
Sarrecchia
Cesare
C
Università di Roma Tor Vergata, Dipartimento di Sanità Pubblica, Rome, Italy. sarrecchia@med.uniroma2.it
Cappelli
Alessandra
A
Aiello
Pasquale
P
D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000009:adverse effects*; D006509:Hepatitis B / Q000209:etiology*; D006510:Hepatitis B Antibodies / Q000097:blood*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D000069283:Rituximab; D014775:Virus Activation / Q000187:drug effects*
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D000069283:Rituximab