title: Fatal reactivation of hepatitis B virus in a patient who was hepatitis B surface antigen negative and core antibody positive before receiving chemotherapy for non-Hodgkin lymphoma.
abstract: Patients who are hepatitis B surface antigen (HBsAg) positive are at risk for hepatitis flare when receiving cytotoxic or immunosuppressive therapy. It has been reported that as high as 50% of HBsAg-positive individuals who undergo chemotherapy develop elevation of liver transaminases. According to current Association for the Study of Liver Diseases guidelines, prophylactic lamivudine should be routinely administered to HBsAg-positive patients with malignancy before chemotherapy. However, occult hepatitis B virus (HBV) infection, defined as HBsAg negative and HBV DNA positive, regardless of HBV core antibody (anti-HBc) status, is not infrequent in HBV endemic areas. Here, we report the case of a B-cell non-Hodgkin lymphoma female patient who was negative for HBsAg, but positive for anti-HBc at the time of chemotherapy. Unfortunately, she developed a fatal HBV reactivation after completing the course of chemotherapy. This case highlights the potential role of lamivudine or other nucleos(t)ide analogue prophylaxis in anti-HBc-positive malignant patient who is about to undergo chemotherapy to provide better coverage for occult HBV infection.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Jia-Min
authors.initials: JM
authors.lastname: Wu
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.forename: Pui-Ching
authors.initials: PC
authors.lastname: Lee
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D000998:Antiviral Agents / Q000008:administration & dosage; D016913:Blood Component Transfusion; D004279:DNA, Viral / Q000097:blood; D017809:Fatal Outcome; D005260:Female; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D006510:Hepatitis B Antibodies / Q000097:blood*; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000188:drug therapy*; D008875:Middle Aged; D019562:Viral Load; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D019259:Lamivudine; C413685:entecavir; D006147:Guanine