Reactions 1209 - 5 Jul 2008

SAntineoplastics

Fatal hepatitis B reactivation in an elderly patient:case report

A 75-year-old woman developed a precore mutant hepatitisB reactivation after receiving an R-CHOP chemotherapyregimen for stage IVb diffuse large B-cell lymphoma.

The hepatitis B virus (HBV)-positive woman (positive HBsurface antigens and HB core antibodies, negative HB surfaceantibodies), received six cycles of R-CHOP chemotherapy withrituximab, cyclophosphamide, doxorubicin, vincristine andprednisone [dosages and duration of treatments not stated];antiviral prophylaxis with lamivudine was started beforechemotherapy and stopped 1 month after its completion. Shedeveloped epigastric pain 1 month later, and presented withabdominal pain, nausea, jaundice and anorexia 2 months later.Laboratory investigations revealed the following levels: totalbilirubin 4.3, AST 3267, ALT 1501 and ALP 215 [units notstated]. Her symptoms continued to worsen; 3 days later, shehad the following laboratory values: total bilirubin 12.1, AST5181, ALT 2460 and ALP 247. She was hospitalised forreactivation of viral hepatitis.

Lamivudine was restarted and the woman receivedsupportive therapy. PCR for HBV revealed 38 000 000 IU/mLof HBV genotype B with the precore mutation G1896A. Herhepatitis worsened despite therapy. She developed severecoagulopathy and fulminant hepatic failure, became obtundedand died. An autopsy was not performed.

Author comment: "This case represents a fatal example ofreactivation of HBV after chemotherapy with R-CHOP."Jonas BA, et al. Precore mutant hepatitis B reactivation following R-CHOPchemotherapy: a case report. Journal of Investigative Medicine 56: 132-133 abstr.89, No. 1, Jan 2008 - USA 801111901

1

Reactions 5 Jul 2008 No. 12090114-9954/10/1209-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved