title: Reactivation of resolved hepatitis B virus infection with immune escape mutations after long-term corticosteroid therapy.
abstract: Hepatitis B virus (HBV) reactivation from resolved infection is a serious problem which can frequently lead to severe hepatitis. Generally, it occurs several months after the start of immunosuppressive therapy; however, it sometimes occurs a few years later, even after cessation of therapy. Here we report a patient with de novo HBV infection who had received corticosteroid therapy for pemphigus vulgaris for 6 years. Full-genome HBV sequence analysis using serial serum samples revealed that the patient was infected with HBV subgenotype C2, which had the G1896R mixed mutation in the precore region. Interestingly, it had the immune escape mutations P120A and G145R in the S gene. Because both hepatitis B surface antigen and antibodies to hepatitis B surface antigen (HBsAb) were positive at the onset of the de novo infection, it was considered that HBV with these mutations escaped from neutralization by the pre-existing HBsAbs. This case indicates that HBV reactivation with an immune escape mutant can occur long after immunosuppressive therapy.
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574, Japan. jinoue-drgn@umin.net.
authors.forename: Jun
authors.initials: J
authors.lastname: Inoue
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Yasuteru
authors.initials: Y
authors.lastname: Kondo
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Wakui
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kogure
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Morosawa
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Fujisaka
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Umetsu
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takai
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba-ku, Sendai, 980-8574, Japan.
authors.forename: Tooru
authors.initials: T
authors.lastname: Shimosegawa
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D004334:Drug Administration Schedule; D006509:Hepatitis B / Q000276:immunology* / Q000821:virology*; D006515:Hepatitis B virus / Q000235:genetics*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D009154:Mutation; D010392:Pemphigus / Q000188:drug therapy; D010802:Phylogeny; D014775:Virus Activation
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents
keywords: G145R; HBV; Immunosuppression; P120A; Pemphigus vulgaris