title: Reactivation of hepatitis B (reverse seroconversion) after melphalan/dexamethasone therapy for primary amyloidosis: a case report.
abstract: BACKGROUND
  Hepatitis B virus (HBV) reactivation (so-called reverse seroconversion) is a rare but known complication of hematopoietic stem cell transplantation, immunosuppressive therapy, or high-dose chemotherapy plus rituximab. This event is linked to a treatment-related fall in titers of antibodies to hepatitis B surface antigen (HBsAb) below the protective threshold level.
  
  
  METHODS
  A 77-year-old Korean man diagnosed with primary amyloidosis was started on melphalan/dexamethasone combination therapy. During treatment, laboratory indices of hepatic function suddenly deteriorated, and he developed acute hepatitis through reverse HBV seroconversion, becoming positive for hepatitis B surface antigen (HBsAg) and negative for HBsAb. HBV DNA was also detectable in serum to a profound extent. Normal liver function was gradually restored during the course of antiviral therapy (entecavir).
  
  
  CONCLUSIONS
  HBV reactivation may lead to fatal liver disease in a significant percentage of patients. As a result, physicians often screen for HBsAg and HBsAb prior to initiating chemotherapy, advising antiviral treatment in patients seropositive for HBsAg, even in the absence of hepatitis B e antigen. Here, a case of HBV reactivation is described, involving a patient given relatively low-dose chemotherapy (melphalan/dexamethasone) for primary amyloidosis.
authors.affiliation: Department of Internal Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea. madgodm@naver.com.
authors.forename: Woo-Ram
authors.initials: WR
authors.lastname: Moon
authors.affiliation: Department of Internal Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea. timex21c@naver.com.
authors.forename: Do-Sik
authors.initials: DS
authors.lastname: Moon
authors.affiliation: Department of Internal Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea. sjoan16@naver.com.
authors.forename: JoA
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea. korean8503@hanmail.net.
authors.forename: Young-Min
authors.initials: YM
authors.lastname: Yoon
authors.affiliation: Department of Medicine, Graduate School of Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea. zeten33@naver.com.
authors.forename: Byung-Seok
authors.initials: BS
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea. chchung@chosun.ac.kr.
authors.forename: Choon-Hae
authors.initials: CH
authors.lastname: Chung
authors.affiliation: Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea. sgpark@chosun.ac.kr.
authors.forename: Sang-Gon
authors.initials: SG
authors.lastname: Park
mesh_terms: D000368:Aged; D000686:Amyloidosis / Q000150:complications* / Q000188:drug therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D000998:Antiviral Agents / Q000627:therapeutic use; D003907:Dexamethasone / Q000009:adverse effects*; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006509:Hepatitis B / Q000209:etiology*; D006510:Hepatitis B Antibodies / Q000097:blood; D006515:Hepatitis B virus / Q000502:physiology*; D006801:Humans; D000075363:Immunoglobulin Light-chain Amyloidosis; D008297:Male; D008558:Melphalan / Q000009:adverse effects*; D014775:Virus Activation / Q000276:immunology
chemical_list: D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; C413685:entecavir; D006147:Guanine; D003907:Dexamethasone; D008558:Melphalan