Hepatitis B virus reactivation during combined therapy with deferiprone and desferioxamine in a hepatitis B surface antigen thalassemic carrier.
In this report we firstly describe a case of reactivation of hepatitis B virus (HBV) replication occurred in a patient affected by Thalassemia major which underwent a combined chelation therapy with desferioxamine (DFO) and deferiprone (DFP). Clinical symptom and increase in alanine aminotransferase (ALT) level were detected when the prescription of DFO (30 mg/kg) was increased from 3 to 5 days/week; a raise in HBV-DNA levels of greater than or equal to tenfold compared with baseline was thereafter detected. Diagnosis was troublesome because increasing ALT levels, first suggested toxicity to DFP administration. However, HBV reactivation in our patient cannot be definitively attributed to combined regimen administration: the patient was on regular transfusion therapy and either coincidental further infection or spontaneous reactivation of HBV could not be completely ruled out. Furthermore, a background of immunologic abnormalities had been previously reported in thalassemia and postulated to be secondary to iron overload or DFO therapy itself.
Ricchi
Paolo
P
Unità Operativa Complessa, Centro delle Microcitemie "A. Mastrobuoni", AORN A. Cardarelli, Naples, Italy. paolo.ricchi@ospedalecardarelli.it.|UOC Microcitemia, Azienda Ospedaliera di Rilievo Nazionale "A. Cardarelli", Via A.Cardarelli 9, 80131, Naples, Italy. paolo.ricchi@ospedalecardarelli.it.
Cinque
Patrizia
P
Unità Operativa Complessa, Centro delle Microcitemie "A. Mastrobuoni", AORN A. Cardarelli, Naples, Italy.
Lanza Galeota
Alfonso
A
Unità Operativa Complessa di Epatologia, AORN A. Cardarelli, Naples, Italy.
Di Matola
Tiziana
T
Centro Traumatologico Ortopedico ASLNA1, Naples, Italy.
Ammirabile
Massimiliano
M
Unità Operativa Complessa, Centro delle Microcitemie "A. Mastrobuoni", AORN A. Cardarelli, Naples, Italy.
Prossomariti
Luciano
L
Unità Operativa Complessa, Centro delle Microcitemie "A. Mastrobuoni", AORN A. Cardarelli, Naples, Italy.
D000328:Adult; D001803:Blood Transfusion; D000077543:Deferiprone; D003676:Deferoxamine / Q000627:therapeutic use; D006509:Hepatitis B / Q000209:etiology* / Q000628:therapy; D006515:Hepatitis B virus / Q000502:physiology; D006801:Humans; D007502:Iron Chelating Agents / Q000627:therapeutic use*; D008297:Male; D011728:Pyridones / Q000627:therapeutic use; D017262:Siderophores; D013789:Thalassemia / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D014775:Virus Activation
D007502:Iron Chelating Agents; D011728:Pyridones; D017262:Siderophores; D000077543:Deferiprone; D003676:Deferoxamine