Fatal Reactivation of Occult Hepatitis B Virus Infection after Rituximab and Chemotherapy in Lymphoma: Necessity of Antiviral Prophylaxis

Zhang, Beibei; Wang, Junxue; Wang, Xu; Wang, Lei; Ni, Wei

doi:10.1159/000319696

Cited by 17 publications

(11 citation statements)

References 9 publications

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“…We suggest to start antiviral therapy with NUCs for patients with HBV-induced cryoglobulinemic vasculitis whose disease severity and activity is mild to moderate. For patients having severe disease (defined as progressive motor neuropathy, or rapid kidney insufficiency, or skin ulcers), a treatment with RTX and/or plasma exchange and/or conventional immunosuppressive agents is recommended, concomitantly with therapy by NUCs as the risk of further HBV reactivation, leading to death in some cases, has been reported (Figure 2) [25,26,27]. Fulminant hepatitis with death due to HCV reactivation in renal transplant recipients who had received RTX therapy has been also noted [28].…”

Section: Discussionmentioning

confidence: 99%

HBV-Associated Cryoglobulinemic Vasculitis: Remission after Antiviral Therapy with Entecavir

Viganò

Martin

Cappelletti

et al. 2014

Kidney Blood Press Res

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Background/Aims: Cryoglobulinemic vasculitis remains an uncommon complication of hepatitis B virus infection. Methods: We report the case of a 40-years old female Chinese patient with chronic hepatitis B developing cryoglobulinemic vasculitis with multiple organ involvement (liver, kidney, and skin) coupled with weakness, arthralgias, haemolytic anaemia, and autoimmune thyroiditis. She received entecavir mono-therapy at dose adjusted for estimated glomerular filtration rate. Results: Within five months of entecavir treatment, hepatitis B viraemia decreased below the limit of detection with normal serum amino-transferase levels, HBeAg clearance occurred, vasculitis regressed with disappearance of purpura and ascites; in addition, renal function normalized and nephritic syndrome remitted. After a five-year follow-up, the patient is asymptomatic with intact kidney function, proteinuria in the normal range, and normal liver biochemistry, despite the antiviral treatment was withdrawn and the patient remained HBsAg positive. Conclusions: This is the second case of hepatitis B virus-related cryoglobulinemic vasculitis successfully treated with entecavir suggesting that effective antiviral therapy may counteract both the hepatic and extra-hepatic manifestations of infection by hepatitis B virus.

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Section: Discussionmentioning

confidence: 99%

HBV-Associated Cryoglobulinemic Vasculitis: Remission after Antiviral Therapy with Entecavir

Viganò

Martin

Cappelletti

et al. 2014

Kidney Blood Press Res

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“…It is recognized that HBV-DNA in liver tissues may work as a carcinogen, even if serum HBV-DNA is not detected. Recently, the concept of occult HBV has received attention after the revelation of fulminant HBV hepatitis developed during immunosuppressive therapy or chemotherapy [10]. Occult HBV is defined as absence of HBs-Ag and presence of HBc-Ab and/or HBs-Ab; it carries a risk of reactivation of HBV hepatitis [11].…”

Section: Discussionmentioning

confidence: 99%

Hepatocellular Carcinoma Developed From Non-Cirrhotic Liver: A Case Report

et al. 2016

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Non-alcoholic steatohepatitis (NASH) is recognized as a crucial factor in the development of hepatocellular carcinoma (HCC) from non-viral cirrhosis. It is generally known that cirrhosis, fibrosis of the liver, works as a carcinogenic promoter, and it is uncommon for non-cirrhotic liver to develop into HCC. Here we report a case of HCC that developed from non-cirrhotic NASH. A 76-year-old male presented to our hospital with abdominal distention. His medical history included impaired glucose tolerance and hypertension. He denied any use of alcohol. Ultrasonography revealed a lobular mass in S5 of the liver with a marginal low echo that measured 50 × 40 mm. Contrast-enhanced computed tomography confirmed HCC. Laboratory analysis revealed normal hepatic and biliary enzymes, as well as normal levels of tumor markers, including alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II. Virus markers were negative for HBs-Ag, HBV-DNA, HCV-Ab, and HCV-RNA. As a result, he was chosen as a candidate for surgical resection; subsegmental resection of S5 and S6 was performed. The resected specimens of the tumor revealed moderately differentiated HCC; rich macrovesicular lipid depositions were observed over the background liver, which was compatible with A2F1. Based on the histological findings, he was diagnosed with HCC developed from non-cirrhotic NASH. This case report is informative for clinicians by raising awareness of the potential risk of HCC in non-cirrhotic NASH.

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“…3,4 Rituximab is also an effective immunosuppressive agent which may lead to HBV replication. 5 Antracyclin based chemotherapy regimens (such as cyclophosphamide, doxorubicin, vincristine and prednisone) with the addition of rituximab (R-CHOP), forms the standard front line therapy in the treatment of CD 20 (+) B cell lymphomas. 6 Rituximab has been found to induce profound and durable B-cell depletion.…”

Section: Discussionmentioning

confidence: 99%

Occult hepatitis B reactivation following rituksimab treatment in a patient with Waldenström macroglobulinemia

Albayrak

Çelebi²,

Tütüncü³

et al. 2012

J Clin Exp Invest

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ÖZETAnti CD 20 monoklonal antikor olan rituksimab B hücreli lenfomaların tedavisinde yaygın olarak kullanılmaktadır. Bir çok çalışmada rituksimab tedavisi sonrası hepatit B virüs (HBV) reaktivasyonu gösterilmiştir. Bu vakaların büyük bir kısmı kronik HBV taşıyıcılarında tanımlanmış olmakla birlikte, gizli hepatit B virüs taşıyıcılarında reaktivasyon gelişebilir.Waldenström Makroglobulinemisi tanısı konulan olgumuzda kemoterapi öncesi bakılan HBsAg (-) ve Anti HBc IgG (+) idi. Hastaya CVP (siklofosfamid, vinkristin, prednizolon) kemoterapisi başlandı. Ancak klinik ve laboratuar olarak yanıt alınamadı ve hasta 3 kürlük CVP tedavisine yanıtsız kabul edildi. Hastaya ikinci basamak tedavi olarak R-CHOP (rituksimab, siklofosfamid, adriamisin, vinkristin ve prednizolon) verilmesi planlandı. 1. kür R-CHOP tedavisi sonrası yapılan tetkiklerde aspartat aminotransferaz (AST) değeri: 267 U/L ve alanin aminotransferaz (ALT) değeri: 318 U/L olarak bulundu. Bakılan HBs Ag (+), HBV DNA: 56400 İU/ml ve Anti HBcIgG (+) olarak saptandı. Lamuvidin 100 mg/gün başlandı. Lamuvidin tedavisinin başlanmasından 4 hafta sonra AST ve ALT değerleri normale döndü. Hasta en son olarak 4. kür R-CHOP tedavisini aldı. AST ve ALT değerleri normal aralıkta olarak takip ediliyor. Bu durum Rituksimab sonrası gelişen gizli hepatit B reaktivasyonu olarak kabul edildi.Bu vakayı sunmamızdaki amaç; Rituksimab gibi immün-süpressif tedavi alan olgularda HBV reaktivasyonu olabileceğine dikkat çekmektir.Anahtar kelimeler: Waldenström makroglobulinemisi, rituksimab, gizli hepatit B enfeksiyonu. ABSTRACTThe anti-CD20 monoclonal antibody rituximab has been used extensively in the treatment of B-cell lymphoma. Several studies reported hepatitis B virus (HBV) reactivation after rituximab. The majority of these cases have been described in chronic carriers of HBV, whereas reactivation in occult hepatitis B virus (OHBV) carriers may occur.The presented case with the diagnosis of Waldenström's macroglobulinemia was HBsAg negative and anti HBcIgG positive before chemotherapy. The patient was started on CVP (cyclophosphamide, vincristine, prednisolone) chemotherapy. However, no clinical or laboratory response was obtained and the patient was considered unresponsive to three cycles of CVP therapy. Therefore R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine and prednisolone) was planned as the second therapy. Laboratory work-up after the first cycle of R-CHOP therapy revealed an aspartate aminotransferase (AST) level of 267 U/L and alanine aminotransferase (ALT) level of 318 U/L. HBsAg and anti HBcIgG were positive and HBV DNA was 56400 IU/ml. Lamivudin 100 mg/day was started. Four weeks after the initiation of lamivudin therapy, ALT and AST levels returned to normal. Currently, the patient has received the fourth cycle of R-CHOP therapy. ALT and AST levels continue to be in normal range. This condition was considered to be the reactivation of OHBV following rituximab.The aim of this case presentation is to call attention to HBV reactivation possibility in cas...

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Fatal Reactivation of Occult Hepatitis B Virus Infection after Rituximab and Chemotherapy in Lymphoma: Necessity of Antiviral Prophylaxis

Cited by 17 publications

References 9 publications

HBV-Associated Cryoglobulinemic Vasculitis: Remission after Antiviral Therapy with Entecavir

HBV-Associated Cryoglobulinemic Vasculitis: Remission after Antiviral Therapy with Entecavir

Hepatocellular Carcinoma Developed From Non-Cirrhotic Liver: A Case Report

Occult hepatitis B reactivation following rituksimab treatment in a patient with Waldenström macroglobulinemia

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