[Impending liver failure after chemoimmunotherapy-induced reactivation  of hepatitis B - successful treatment with entecavir].
METHODS
An 83-year old woman had been treated with bendamustin and rituximab for prolymphocytic leukemia. Two weeks after cycle 6 of chemotherapy, signs and symptoms of a severe hepatitis occurred.


METHODS
Highly elevated values for AST (1353 U/l) and bilirubin (27.8 mg/dl), impaired coagulation parameters (INR 1,68) and the detection of ascites led to the diagnosis of an impending liver failure induced by reactivation of a hitherto unknown hepatitis B (HBs antigen pos., HBe antigen pos., anti HBc IgG pos., HBV DNA 1,65 Mio copies/ml).


METHODS
After an immediately started treatment with entecavir (0.5 mg/d po), symptoms and laboratory parameters rapidly improved. 4 months later liver chemistry was completely normal and HBV DNA was negative. After 8 months, a seroconversion to anti HBs was noted.


CONCLUSIONS
In single cases, life threatening complications of chemotherapy induced reactivation of hepatitis B may be successfully treated by potent and stabile nucleosidanalogs.
Klinik für Innere Medizin, Albertinenkrankenhaus Hamburg. guntram.lock@albertinen.de
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G
Lock
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Helmich
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Bertram
D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D000069461:Bendamustine Hydrochloride; D003937:Diagnosis, Differential; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006509:Hepatitis B / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy*; D006515:Hepatitis B virus / Q000187:drug effects* / Q000502:physiology*; D006801:Humans; D007121:Immunocompetence / Q000187:drug effects; D015463:Leukemia, Prolymphocytic / Q000188:drug therapy*; D017093:Liver Failure / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy*; D008111:Liver Function Tests; D009588:Nitrogen Mustard Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D000069283:Rituximab; D014775:Virus Activation / Q000187:drug effects*
D058846:Antibodies, Monoclonal, Murine-Derived; D000998:Antiviral Agents; D009588:Nitrogen Mustard Compounds; D000069283:Rituximab; C413685:entecavir; D006147:Guanine; D000069461:Bendamustine Hydrochloride