title: Successful use of entecavir for a severe case of reactivation of hepatitis B virus following polychemotherapy containing rituximab.
abstract: OBJECTIVE
  Hepatitis B virus (HBV) reactivation following treatment with rituximab has been reported in patients with either HBsAg-positive, or HBsAg-negative and anti-HBc positive infection. Patients with severe reactivation often have a fatal outcome despite treatment with lamivudine. The use of entecavir has not been reported in patients with severe HBV reactivation.
  
  
  METHODS
  We present a case of a HBsAg-negative patient diagnosed with chronic lymphocytic leukemia who received a chemotherapeutic regimen that included rituximab, who subsequently presented with severe HBV reactivation with ascites, jaundice and coagulopathy and was treated with entecavir. A review of the literature and underlying HBV associated mutations are discussed.
  
  
  RESULTS
  Entecavir produced a rapid and sustained suppression of HBV that was associated with rapid clinical improvement without any side effects.
  
  
  CONCLUSIONS
  Entecavir is an efficacious and safe treatment for severe HBV reactivation.
authors.affiliation: Hospital Vall d'Hebron, Liver Unit, CIBERehd Institute Carlos III, Paseo de Vall d'Hebron, 08035 Barcelona, Spain.
authors.forename: Mayra J
authors.initials: MJ
authors.lastname: Sanchez
authors.forename: Maria
authors.initials: M
authors.lastname: Buti
authors.forename: Maria
authors.initials: M
authors.lastname: Homs
authors.forename: Andres
authors.initials: A
authors.lastname: Palacios
authors.forename: Francisco
authors.initials: F
authors.lastname: Rodriguez-Frias
authors.forename: Rafael
authors.initials: R
authors.lastname: Esteban
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D000998:Antiviral Agents / Q000627:therapeutic use*; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006509:Hepatitis B / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009154:Mutation; D012008:Recurrence; D000069283:Rituximab; D014740:Vidarabine / Q000009:adverse effects / Q000031:analogs & derivatives
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents; D000069283:Rituximab; C413685:entecavir; D006147:Guanine; D014740:Vidarabine; C024352:fludarabine