title: Fatal liver failure caused by reactivation of lamivudine-resistant hepatitis B virus: a case report.
abstract: We present a case of fetal liver failure caused by the activation of lamivudine-resistant hepatitis B virus (HBV) nine months after lamivudine treatment. A 57-year old man visited our hospital for the treatment of decompensated chronic hepatitis B. Lamivudine was started in December 2001. Subsequently, serum HBV was negative for HBV DNA with seroconversion from HBeAg to anti-HBe and improvement of liver function. However, HBV DNA and HBeAg were again detected in September 2002. He was complicated by breakthrough hepatitis and admitted to our hospital in November for severely impaired liver function. Vidarabine treatment was started and serum HBV DNA and alanine aminotransferase (ALT) decreased transiently. However, after the start of alpha-interferon treatment, HBV DNA level increased and liver function deteriorated. He died 1 mo after admission. An analysis of amino acid sequences in the polymerase region revealed that rtM204I/V with rtL80I/V occurred at the time of viral breakthrough. After the start of antiviral treatment, rtL180M was detected in addition to rtM204I/V and rtL80I/V, and became predominant in the terminal stage of the disease. HBV clone with a high replication capacity may be produced by antiviral treatment leading to the worsening of liver function. Antiviral therapy for patients with breakthrough hepatitis in advanced liver disease should be carefully performed.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yotsuyanagi
authors.forename: Chiaki
authors.initials: C
authors.lastname: Okuse
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Nagase
authors.forename: Hideaki
authors.initials: H
authors.lastname: Takahashi
authors.forename: Kyoji
authors.initials: K
authors.lastname: Moriya
authors.forename: Michihiro
authors.initials: M
authors.lastname: Suzuki
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
authors.forename: Shiro
authors.initials: S
authors.lastname: Iino
authors.forename: Fumio
authors.initials: F
authors.lastname: Itoh
mesh_terms: D000595:Amino Acid Sequence; D000998:Antiviral Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D017809:Fatal Outcome; D015684:Gene Products, pol / Q000032:analysis; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D006515:Hepatitis B virus / Q000201:enzymology / Q000472:pathogenicity* / Q000502:physiology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D017093:Liver Failure / Q000175:diagnosis / Q000821:virology*; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation
chemical_list: D000998:Antiviral Agents; D015684:Gene Products, pol; C066027:P protein, Hepatitis B virus; D019259:Lamivudine