title: Acute fulminant hepatitis B in a patient with diabetic nephropathy treated successfully with concomitant lamivudine and molecular adsorbents recirculating system.
abstract: A 36-year-old man with type 2 diabetes and diabetic nephropathy treated with hemodialysis developed hepatitis B virus (HBV)-induced acute fulminant hepatic failure (FHF). Despite supportive treatment, the condition rapidly progressed as manifested by severe jaundice, coagulopathy and hepatic coma. He was placed on the waiting list for liver transplantation and was treated with lamivudine and extracoporeal liver support with the molecular adsorbent recirculating system (MARS). After three 8-h sessions of MARS treatment in 1 week, he had remarkable improvement in clinical symptoms and serum biochemistry. On the 14th hospital day, surface antigen seroconversion was noted with undetectable hepatitis B virus surface antigen (HBs Ag) and low titre of anti-HBs antibody, indicating a complete recovery from acute fulminant hepatitis B. MARS treatment has been reported to benefit patients with liver failure from different causes including acute exacerbation of chronic hepatitis B, poisoning, post transplantation and Wilson's disease. The present case suggests its potential benefit when combined with lamivudine in treating uremic patients with acute fulminant hepatitis B.
authors.affiliation: Division of Gastroenterology, Department of Medicine, National Defense Medical Center, Tri-Service General Hospital, No. 325, Section 2 Cheng-Kung Road, Neihu 114, Taipei, Taiwan, ROC.
authors.forename: Shih-Hung
authors.initials: SH
authors.lastname: Tsai
authors.forename: Hao-Ming
authors.initials: HM
authors.lastname: Chang
authors.forename: Chung-Bao
authors.initials: CB
authors.lastname: Hsieh
authors.forename: You-Chen
authors.initials: YC
authors.lastname: Chao
authors.forename: Tsai-Yuan
authors.initials: TY
authors.lastname: Hsieh
mesh_terms: D000208:Acute Disease; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D017583:Hemodiafiltration / Q000379:methods*; D006509:Hepatitis B / Q000188:drug therapy / Q000628:therapy; D006515:Hepatitis B virus / Q000187:drug effects; D006801:Humans; D017114:Liver Failure, Acute / Q000188:drug therapy* / Q000628:therapy; D008297:Male; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents