title: Immune-mediated hepatitis-associated aplastic anemia caused by the emergence of a mutant hepatitis B virus undetectable by standard assays.
abstract: Hepatitis-associated aplastic anemia (HAA) is characterized by marrow failure developing after acute seronegative hepatitis. A patient with agammaglobulinemia developed HAA in association with HBsAg-negative, hepatitis B virus (HBV) DNA-positive acute hepatitis. Sequence analysis showed several substitutions in the major antigenic determinant of HBsAg, potentially affecting the detection by diagnostic immunoassays. Viral mutants may therefore be implicated as etiologic agents of HBsAg-negative HAA. HBV DNA determination may be necessary to exclude mutant HBV as a cause of HAA, particularly in categories at high risk of mutant selection such as agammaglobulinemic and transplanted patients.
authors.affiliation: Department of Experimental and Applied Medicine, Section of Microbiology, University of Brescia, A.O. Spedali Civili, Brescia, Italy. ecariani@hotmail.com
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Cariani
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Pelizzari
authors.forename: Anna
authors.initials: A
authors.lastname: Rodella
authors.forename: Franco
authors.initials: F
authors.lastname: Gargiulo
authors.forename: Luisa
authors.initials: L
authors.lastname: Imberti
authors.forename: Nino
authors.initials: N
authors.lastname: Manca
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rossi
mesh_terms: D000208:Acute Disease; D000361:Agammaglobulinemia / Q000150:complications; D000741:Anemia, Aplastic / Q000209:etiology* / Q000821:virology; D004279:DNA, Viral; D000939:Epitopes; D006509:Hepatitis B / Q000150:complications* / Q000276:immunology / Q000821:virology*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics*; D019693:Hepatitis, Autoimmune / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation
chemical_list: D004279:DNA, Viral; D000939:Epitopes; D006514:Hepatitis B Surface Antigens