Fatal postlymphoma chemotherapy hepatitis B reactivation secondary to the emergence of a YMDD mutant strain with lamivudine resistance in a noncirrhotic patient.
Hepatitis B reactivation is a well-known complication during or after chemotherapy in chronic hepatitis B (HBV) carriers. The current practice guidelines in Canada and the United States recommends patients receive antiviral prophylaxis prior to the onset of chemotherapy in chronic HBV carriers with lamivudine. We report a case of a 57-year-old man with follicular lymphoma on lamivudine prophylaxis and no clinical evidence of cirrhosis, and developed fatal HBV reactivation after the emergence of a YMDD mutant strain of HBV that confers lamivudine resistance. Fatal reactivation secondary to the development of lamivudine resistance has not, to date, been well- reported. Our experience indicates the need to carefully monitor patients for suspected drug- resistant HBV mutants with the addition of anti-viral agents effective against the YMDD mutational strain, when lamivudine resistance emerges.
Law
Joanna K
JK
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Ali
Jaber Al
JA
Harrigan
P Richard
PR
Sherlock
Christopher H
CH
Savage
Kerry J
KJ
Yoshida
Eric M
EM
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D024882:Drug Resistance, Viral / Q000187:drug effects / Q000235:genetics; D017809:Fatal Outcome; D019694:Hepatitis B, Chronic / Q000150:complications / Q000235:genetics / Q000517:prevention & control*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage* / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000209:etiology / Q000235:genetics; D008224:Lymphoma, Follicular / Q000150:complications / Q000188:drug therapy / Q000821:virology; D008297:Male; D008875:Middle Aged; D009154:Mutation; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D014775:Virus Activation / Q000187:drug effects*
D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine