Development of de novo hepatitis B in patient during follow-up of liver-graft-versus-host disease associated with allogeneic peripheral blood stem cell transplantation

Abstract

A 66-year-old female patient with acute myeloid leukemia underwent remission-induction therapy and allogeneic peripheral stem cell transplantation. The patient was found to have a resolved hepatitis B virus (HBV) infection, as shown by her positivity for the hepatitis B surface (HBs) antibody and hepatitis B core antibody and negativity for the HBs antigen and HBV-DNA. Administration of an immunosuppressant was started after transplantation for the prevention of graft-versus-host disease (GVHD), and hepatic impairment developed four months after transplantation. No changes were observed in serum HBV-related marker levels, and a liver biopsy revealed GVHD. The course of hepatic impairment was followed up with the diagnosis of liver GVHD, without determining the level of HBV-related markers. Hepatic impairment recurred 13 months after transplantation. Determination of the HBV-related markers showed that the patient was positive for the HBs antigen and HBV-DNA. The patient was diagnosed as having de novo hepatitis B, and the hepatitis improved after the start of anti-viral therapy. In administering immunosuppressive therapy and chemotherapy for patients with a resolved HBV infection, it is important to test for viral markers regularly by paying constant attention to the possible onset of de novo hepatitis B, despite the existing hepatic disease.