title: [Hepatitis-B reactivation during treatment with tumor necrosis  factor-α blocker adalimumab in a patient with psoriasis arthritis].
abstract: METHODS
  A 66-year-old man with acute fever, myalgia, arthralgia, restricted movement and neck stiffness was admitted to our emergency unit. Three weeks earlier treatment with adalimumab, a tumor necrosis factor(TNF)-alpha antagonist was started by the patient's dermatologist because of a psoriasis vulgaris with associated psoriasis arthritis. All previous laboratory tests where without pathological findings.
  
  
  METHODS
  The imaging procedures showed no pathological findings. Transaminase and CRP levels were markedly elevated. Hepatitis serology revealed reactivation of a chronic hepatitis B infection, while a combined viral and toxic hepatitis was detected by liver biopsy.
  
  
  METHODS
  On the day of admittance acute neurological symptoms developed including muscular cramps and dyskinesia. Hypotonia and tachyarrhythmia were treated with parenteral infusions and digitoxin. Reactivation of a chronic hepatitis B infection with subfulminant liver failure was diagnosed, caused by immunosuppressive therapy with adalimumab. The patient was transferred to be treated with the antiviral drug entecavir.
  
  
  CONCLUSIONS
  The exclusion of acute and/or chronic hepatitis before using TNF-alpha antagonists is recommended but in daily routine often ignored. The presented case demonstrates the risk of reactivating a chronic hepatitis B during therapy with a TNF-alpha antagonist.
authors.affiliation: Klinik für Innere Medizin und Rheumatologie, Zeisigwaldkliniken Bethanien, Chemnitz. matthias_kouba@gmx.at
authors.forename: M
authors.initials: M
authors.lastname: Kouba
authors.forename: S E
authors.initials: SE
authors.lastname: Rudolph
authors.forename: P
authors.initials: P
authors.lastname: Hrdlicka
authors.forename: M A
authors.initials: MA
authors.lastname: Zuber
mesh_terms: D000068879:Adalimumab; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000473:pathology*; D003937:Diagnosis, Differential; D006509:Hepatitis B / Q000139:chemically induced* / Q000473:pathology*; D006515:Hepatitis B virus / Q000187:drug effects*; D006801:Humans; D008099:Liver / Q000473:pathology; D017093:Liver Failure / Q000139:chemically induced / Q000473:pathology; D008297:Male; D011565:Psoriasis / Q000188:drug therapy*; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D000068879:Adalimumab