title: Severe acute hepatitis B in a treatment-naïve patient with antiviral drug resistant mutations in the polymerase gene.
abstract: This is a case of 62 years old Caucasian treatment-naïve patient who developed a severe acute hepatitis B infection soon after a trip to Thailand. The infection was due to genotype C HBV which was found to be resistant to lamivudine and telbivudine. The patient was treated with tenofovir resulting in complete suppression of viral replication and complete clinical and laboratory remission of acute hepatitis. Later the patient also developed seroconversion of HBeAg to anti-HBe and of HBsAg to anti-HBs. This case demonstrates that mutations of HBV polymerase associated with lamivudine, telbivudine, and adefovir resistance can be present also in untreated patients with severe acute hepatitis B. This suggests that in the clinical context, which represents a life threatening condition, a baseline resistance-testing should be an additional marker in the diagnostic evaluation process. Finally, this case report seems to support the use of tenofovir for the immediate treatment of severe acute hepatitis B.
authors.affiliation: Department of Medicine, DIMED, University of Padova, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Morando
authors.forename: Silvia
authors.initials: S
authors.lastname: Rosi
authors.forename: Silvano
authors.initials: S
authors.lastname: Fasolato
authors.forename: Marta
authors.initials: M
authors.lastname: Cavallin
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Gola
authors.forename: Angelo
authors.initials: A
authors.lastname: Gatta
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
mesh_terms: D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000998:Antiviral Agents / Q000008:administration & dosage / Q000494:pharmacology; D004279:DNA, Viral / Q000235:genetics; D024882:Drug Resistance, Viral; D005838:Genotype; D006509:Hepatitis B / Q000473:pathology* / Q000821:virology*; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics* / Q000302:isolation & purification*; D006801:Humans; D007558:Italy; D019259:Lamivudine / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D020125:Mutation, Missense; D063065:Organophosphonates / Q000008:administration & dosage; D000077712:Telbivudine; D000068698:Tenofovir; D013785:Thailand; D013936:Thymidine / Q000031:analogs & derivatives / Q000494:pharmacology; D014195:Travel; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens; D063065:Organophosphonates; D000077712:Telbivudine; D019259:Lamivudine; D000068698:Tenofovir; D000225:Adenine; D013936:Thymidine