Reactions 1193 - 15 Mar 2008

★ SAntineoplastics

Reactivation of hepatitis B virus (first report withvinblastine) in an elderly patient: case report

A 66-year-old woman, who had a history of hepatitis B virusinfection, experienced a reactivation of the virus after receivingantineoplastic therapy for Hodgkin’s disease.

Prior to antineoplastic therapy, the woman was negative forhepatitis B surface antigen (HBsAg) and positive for hepatitis Bcore antibody (anti-HBc). She received six cycles ofantineoplastic therapy comprising bleomycin,dexamethasone, doxorubicin and vinblastine [dosages notstated]. A few days after her sixth antineoplastic cycle, shedeveloped asthenia, choluria, acholia and jaundice affectingher skin and mucosa. Tests revealed the following:haemoglobin 10.2 g/dL, leucocyte count 3500 cells/dL, plateletcount 97 000 platelets/dL, total bilirubin 11.2 mg/dL, directbilirubin 8 mg/dL, AST 853 U/L, ALT 935 U/L, γ-glutamyltransferase 336 U/L, ALP 216 U/L, total protein 3.8 g/dL,albumin 3 g/dL and prothrombin time 16.5 seconds. Serologytests revealed that she was positive for HBsAg, anti-HBc andHBe[A]g, and negative for anti-HBc IgM. Her hepatitis B virusDNA level was 27 600 000 U/mL.

The woman was treated with lamivudine. However, duringthe following days, her jaundice worsened and her AST andALT levels increased to 1787 U/L and 1156 U/L, respectively.Adefovir was administered in addition to lamivudine and hertransaminase and bilirubin levels gradually decreased, with abiochemical response evident after 7 days. Her hepatitis Bvirus DNA level had decreased to 6461 U/mL and she wasdischarged from hospital. She died a few months later afterdeveloping spongiform encephalopathy.

Author comment: In the majority of cases, reactivation ofhepatitis B virus infection occurs in HBsAg carriers withhaematological neoplasias, in particular lymphomas, that aretreated with antineoplastics. Less commonly, reactivation mayoccur in HBsAg negative patients. In these patients, there is adrastic reduction in anti-HBs levels and they become HBsAgpositive again.Castello Miralles I, et al. Adefovir in reactivation of chemotherapy-inducedhepatitis B in an anti-Hbc-positive patient. Gastroenterologia y Hepatologia 30:563, No. 9, Nov 2007 [Spanish; summarised from a translation] -Spain 801079415

» Editorial comment: A search of AdisBase, Medline andEmbase did not reveal any previous case reports of viralhepatitis associated with vinblastine. The WHO Adverse DrugReactions database contained three reports of viral hepatitisassociated with vinblastine.

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Reactions 15 Mar 2008 No. 11930114-9954/10/1193-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved