Successful use of entecavir for a severe case of reactivation of hepatitis B virus following polychemotherapy containing rituximab.
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.
Sanchez
Mayra J
MJ
Hospital Vall d'Hebron, Liver Unit, CIBERehd Institute Carlos III, Paseo de Vall d'Hebron, 08035 Barcelona, Spain.
Buti
Maria
M
Homs
Maria
M
Palacios
Andres
A
Rodriguez-Frias
Francisco
F
Esteban
Rafael
R
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
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