The putative acceleration of optic neuritis when combined with chronic hepatitis B

Zhao, Shilei; Chen, Tingjun; Peng, Chunxia; Zhou, Huanfen; Li, Hongyang; Huang, Dehui; Xu, Quangang; Wei, Shimin

doi:10.1016/j.jns.2015.08.1538

Cited by 7 publications

(13 citation statements)

References 31 publications

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“…In 2014, Toosy et al [ 10 ] proposed the concept of typical and atypical ON according to the relationship of ON to either multiple sclerosis or demyelinating disease of the CNS. Zhao et al [ 7 ] showed that 92.3% of patients with ON and HBV infection were atypical. Our patient reported no history of autoimmune diseases and infection or close contact, except for being diagnosed as an HBV carrier.…”

Section: Discussionmentioning

confidence: 99%

Neuromyelitis optica spectrum disorder with active replication of hepatitis B virus and seropositive anti-aquaporin-4 antibody

Lei

Wang

2021

Medicine

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Rationale: Neuromyelitis optica spectrum disorder (NMOSD) associated with active replication of hepatitis B virus (HBV) is rare. High-dose corticosteroids are the mainstay treatment of NMOSD; however, these may cause reactivation of viral replication in patients with stable HBV which may lead to liver damage. Therefore, care should be placed in corticosteroid use in patients with NMOSD and HBV infection. Patient concerns: Herein, we report the case of a 31-year-old woman with NMOSD and HBV infection who was seropositive for anti-aquaporin-4 antibody. The stable and HBV carrier status of the patient led to the deferment of antiviral and hepatoprotective agents in early treatment. However, liver function impairment was detected during follow-up, with an improvement in the best-corrected visual acuity. Diagnoses: The patient was diagnosed with NMOSD with active replication of HBV and seropositive anti-aquaporin-4 antibody considering the medical history and ancillary examinations. Interventions: To manage NMOSD, intravenous high-dose methylprednisolone (20 mg/kg d) was administered for 5 days which was gradually tapered to oral steroids. However, liver function impairment was observed during follow-up; therefore, anti-HBV drugs (entecavir) and hepatoprotective drugs (bicyclol or polyunsaturated phosphatidylcholine) were administered. Outcomes: A marked improvement was observed in the patient's best-corrected visual acuity after 4 weeks of treatment. However, follow-up examinations revealed liver function damage which necessitated administration of antiviral and hepatoprotective drugs. Liver function normalized after 1 month. Lesson: This case underscores the importance of preventive treatment of liver protection in patients with HBV infection prior to or simultaneous with glucocorticoid therapy and furthermore, there is an urgent need to develop authoritative guidelines regulating corticosteroid use in the treatment of patients with HBV infection.

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Section: Discussionmentioning

confidence: 99%

Neuromyelitis optica spectrum disorder with active replication of hepatitis B virus and seropositive anti-aquaporin-4 antibody

Lei

Wang

2021

Medicine

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“…About 20% of HBV patients develop extrahepatic manifestations [4]. Different studies or case reports showed that HBV infection and vaccination are associated with the onset of CNS demyelinating diseases, such as multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), optic neuritis (ON), and transverse myelitis (TM) [5][6][7][8][9]. For example, Zhao et al [6] showed that CHB infection may lead to ON worsening [6].…”

Section: Introductionmentioning

confidence: 99%

“…Different studies or case reports showed that HBV infection and vaccination are associated with the onset of CNS demyelinating diseases, such as multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), optic neuritis (ON), and transverse myelitis (TM) [5][6][7][8][9]. For example, Zhao et al [6] showed that CHB infection may lead to ON worsening [6]. Heekin et al [10] described a patient who developed seronegative neuromyelitis optica spectrum disorder (NMOSD) after the exposure to recombinant hepatitis B vaccine [10].…”

Section: Introductionmentioning

confidence: 99%

Comprehensive analysis of patients with neuromyelitis optica spectrum disorder (NMOSD) combined with chronic hepatitis B (CHB) infection and seropositive for anti-aquaporin-4 antibody

Liu

Chen

et al. 2017

Bosn J of Basic Med Sci

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Previous research indicated the association between hepatitis B virus (HBV) infection/vaccination and the onset of demyelinating diseases. However, most of these studies were single case reports, and comprehensive data are still scarce. Here we present a comprehensive analysis of 10 patients with neuromyelitis optica spectrum disorder (NMOSD) combined with chronic hepatitis B (CHB) infection and seropositive for anti-aquaporin-4 antibody (AQP4-Ab). Demographic, clinical, laboratory, neuroimaging, outcome, and follow-up data of the 10 patients were retrospectively analyzed. The median age at the onset of NMOSD was 35 years (range 25-43). Nine patients were female (90%). All patients were positive for HBsAg and had been diagnosed with CHB earlier than with NMOSD. One patient had an autoimmune disease. All patients had normal thyroid function. Paresthesia and visual impairment were the most common clinical symptoms. The cerebrospinal fluid (CSF) parameters (protein and glucose) were normal in 10 cases, whereas slightly higher CSF white blood cell count was detected in 3 patients. The brain and spinal cord magnetic resonance imaging findings were abnormal in 8 patients. All patients were treated with hormone and immunosuppressive therapy, and anti-HBV agents. Patients with detectable serum HBV DNA were more prone to liver damage after receiving high doses of corticosteroids. In 8 patients, the symptoms improved before they were discharged. Two patients with optic neuritis (ON) maintained the symptoms. A month later, 1/8 patient had recurrence of symptoms, and one ON patient progressed to NMO. Overall, the characteristics of NMOSD patients with CHB and seropositive for AQP4-Ab are usually nonspecific. Abnormal liver function test results in NMOSD patients should be a warning of possible CHB infection, and the treatment should be modified accordingly.

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“…[11] Kumar et al found low levels of HBVDNA <5.0 pg/mL (141,500 copies/mL) in 96% of AVH-B, while in patients with CHB-AE, the HBVDNA was >5.0 pg/mL ( P < .001). [12] Therefore, according to our previous studies, [5] the diagnosis may be the CHB-AE related ON, but actually we cannot distinguish CHB-AE and AVH-B clearly. Eventually, we diagnosed the disease as HB-ON.…”

Section: Discussionmentioning

confidence: 94%

“…Optic neuritis combined with hepatitis B has been rarely reported, mainly including ON combined with chronic hepatitis B (CHB) [5] and HBV vaccination, [6] ON combined with acute hepatitis B or acute exacerbations of chronic hepatitis B have not been reported so far. In our case, the patient suffered an acute visual loss with eye pain and the RAPD in the left eye after hepatitis B.…”

Section: Discussionmentioning

confidence: 99%

A case report of hepatitis B related optic neuritis treated with plasma exchange

et al. 2019

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Introduction: There are few studies focusing on Binocular hepatitis B related optic neuritis (HB-ON) and associated therapies are still limited. We present a case of HB-ON which has been cured with therapeutic plasma exchange (TPE). Patient concerns: The patient was diagnosed as acute hepatitis B in hepatology and got a rapid loss of binocular visual acuity (2/100 in the right eye and no light perception in the left eye) after the onset. Diagnosis: Hepatitis B related optic neuritis. Interventions: Methylprednisolone and therapeutic plasma exchange. Outcomes: The treatment of high dose methylprednisolone was not curative. After 5 TPE sessions, the patient's best corrected visual acuity (BCVA) returned to 20/20 in the right eye and finger counting (FC)/40 cm in the left eye. One month later, the visual acuity increased to 5/100 in the left eye. Conclusion: This is the first case in which we used TPE to cure HB-ON. Also, it can demonstrate the relationship between HB-ON and immunopathogenesis. The case may provide an effective method for the treatment of hormone invalid and disabled ON in clinical practice.

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The putative acceleration of optic neuritis when combined with chronic hepatitis B

Cited by 7 publications

References 31 publications

Neuromyelitis optica spectrum disorder with active replication of hepatitis B virus and seropositive anti-aquaporin-4 antibody

Neuromyelitis optica spectrum disorder with active replication of hepatitis B virus and seropositive anti-aquaporin-4 antibody

Comprehensive analysis of patients with neuromyelitis optica spectrum disorder (NMOSD) combined with chronic hepatitis B (CHB) infection and seropositive for anti-aquaporin-4 antibody

A case report of hepatitis B related optic neuritis treated with plasma exchange

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