Subfulminant hepatitis B after infliximab in Crohn's disease: need for HBV-screening?
Infections are a major adverse effect during the treatment with anti-TNF-alpha. While exclusion of any bacterial infection and screening for tuberculosis are mandatory before initiating a therapy with anti-TNF-alpha-antibodies, there are no guidelines whether to screen for or how to deal with chronic viral infections such as hepatitis B. In this case report, we have described a patient with Crohn's disease who developed subfulminant hepatitis B after the fourth infusion of infliximab due to an unrecognized HBs-antigen carrier state. He recovered completely after lamivudine therapy was started, but this severe adverse event could have been prevented if screening for HBV and pre-emptive therapy with lamivudine would have been started prior to infliximab. We therefore strongly argue in favor of extended screening recommendations for infectious diseases including viral infections before considering a therapy with infliximab.
Millonig
Gunda
G
Department of Gastroenterology and Hepatology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. gunda.millonig@uibk.ac.at
Kern
Michaela
M
Ludwiczek
Othmar
O
Nachbaur
Karin
K
Vogel
Wolfgang
W
D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D003424:Crohn Disease / Q000188:drug therapy*; D006509:Hepatitis B / Q000175:diagnosis*; D006515:Hepatitis B virus / Q000302:isolation & purification*; D006801:Humans; D000069285:Infliximab; D008297:Male; D008403:Mass Screening; D008875:Middle Aged
D000911:Antibodies, Monoclonal; D000069285:Infliximab