title: Successful treatment with adefovir of one patient whose cryoglobulinemic vasculitis relapsed under lamivudine therapy and who was diagnosed to have HBV virologic breakthrough with YMDD mutations.
abstract: We report a patient whose cryoglobulinemic vasculitis recurred due to reactivation of lamivudine-resistant HBV. Our patient with hepatitis B-related cryoglobulinemic vasculitis was administered lamivudine. Her vasculitis regressed, ALT normalized, HBV-DNA became negative. Under lamivudine therapy, her cryoglobulinemic cutaneous vasculitis recurred. ALT increased significantly; it was found that tyrosine-methionine-aspartate-aspartate (YMDD) motif in the DNA polymerase gene had been replaced by YIDD. Adefovir was added to lamivudine. During follow-up, her purpura disappeared, ALT normalized, HBV-DNA became negative. Our patient is the first whose cryoglobulinemic vasculitis recurred under lamivudine, who had a HBV virologic breakthrough with YMDD mutation, and was successfully treated with adefovir.
authors.affiliation: Department of Rheumatology, Trakya University Medical Faculty, Edirne-TURKEY.
authors.forename: Necati
authors.initials: N
authors.lastname: Cakir
authors.forename: Omer Nuri
authors.initials: ON
authors.lastname: Pamuk
authors.forename: Hasan
authors.initials: H
authors.lastname: Umit
authors.forename: Kenan
authors.initials: K
authors.lastname: Midilli
mesh_terms: D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D020816:Amino Acid Motifs / Q000235:genetics; D001224:Aspartic Acid / Q000235:genetics; D003449:Cryoglobulinemia / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics*; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics*; D006515:Hepatitis B virus / Q000235:genetics; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008715:Methionine / Q000235:genetics; D008875:Middle Aged; D009154:Mutation; D063065:Organophosphonates / Q000627:therapeutic use*; D012008:Recurrence; D014443:Tyrosine / Q000235:genetics; D014657:Vasculitis / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics*
chemical_list: D063065:Organophosphonates; D019259:Lamivudine; D001224:Aspartic Acid; D014443:Tyrosine; C053001:adefovir; D008715:Methionine; D000225:Adenine