title: Hepatitis B Leading to Megaloblastic Anemia and Catastrophic Peripheral Thrombocytopenia.
abstract: Hepatitis B virus (HBV) typically causes chronic hepatitis, cirrhosis, and hepatocellular carcinoma. It is associated with a variety of extrahepatic complications. We herein, present a rare extrahepatic complication of HBV infection. A 32-year man presented with melena, bleeding from gums and fever. Peripheral blood examination revealed anemia, macrocytosis and severe thrombocytopenia. His hepatitis B surface antigen (HBsAg) was positive but deoxyribonucleic acid (HBV DNA) by polymerase chain reaction (PCR) was negative. Other hepatitis, human immune deficiency virus (HIV), dengue, and autoimmune serology were negative. Bone marrow examination revealed megaloblastic erythropoiesis. There was mild to moderate reduction of megakaryocytes in bone marrow, which was not compatible with severe peripheral thrombocytopenia. His response to cyanocobalamin and folic acid was remarkable for myeloid cell lines and moderate for erythroid cell lines, but poor to platelet counts. Platelet counts gradually improved to safe limits with eltrombopag, likely reflecting autoimmune pathogenesis for thrombocytopenia. This case report highlights multiple targets of HBV infection with associated multiple pathogenetic mechanisms.
authors.affiliation: Department of Gastroenterology, Combined Military Hospital, Kharian.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Hafeez
authors.affiliation: Department of Pathology, Combined Military Hospital, Kharian.
authors.forename: Tariq
authors.initials: T
authors.lastname: Sarfraz
authors.affiliation: Department of Medicine, Combined Military Hospital, Kharian.
authors.forename: Raja Ghayas
authors.initials: RG
authors.lastname: Khan
authors.affiliation: Department of Ophthalmology, Combined Military Hospital, Kharian.
authors.forename: Abdul
authors.initials: A
authors.lastname: Rafe
authors.affiliation: Department of Cardiology, Combined Military Hospital, Kharian.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Rasool
authors.affiliation: Department of Haematology, Combined Military Hospital, Kharian.
authors.forename: Kamran Nazir
authors.initials: KN
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D000749:Anemia, Megaloblastic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D001565:Benzoates / Q000627:therapeutic use; D005492:Folic Acid / Q000008:administration & dosage; D005494:Folic Acid Deficiency / Q000150:complications / Q000188:drug therapy; D006509:Hepatitis B / Q000150:complications*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus; D006801:Humans; D006834:Hydrazines / Q000627:therapeutic use; D008297:Male; D010976:Platelet Count; D016133:Polymerase Chain Reaction; D011720:Pyrazoles / Q000627:therapeutic use; D000068698:Tenofovir / Q000008:administration & dosage / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D014805:Vitamin B 12 / Q000008:administration & dosage / Q000627:therapeutic use; D014806:Vitamin B 12 Deficiency / Q000150:complications / Q000188:drug therapy; D014803:Vitamin B Complex / Q000008:administration & dosage
chemical_list: D001565:Benzoates; D006514:Hepatitis B Surface Antigens; D006834:Hydrazines; D011720:Pyrazoles; D014803:Vitamin B Complex; D005492:Folic Acid; D000068698:Tenofovir; D014805:Vitamin B 12; C520809:eltrombopag