Journal of the Chinese Medical Association
Volume 73, Issue 3 , Pages 156-160, March 2010

Hepatitis B Virus Reactivation After 23 Months of Rituximab-based Chemotherapy in an HBsAg-negative, Anti-HBs-positive Patient With Follicular Lymphoma

  • I-Cheng Lee

      Affiliations

    • Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Yi-Hsiang Huang

      Affiliations

    • Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Yi-Hsiang Huang, Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.
    • ,
  • Chi-Jen Chu

      Affiliations

    • Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Pui-Ching Lee

      Affiliations

    • Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Han-Chieh Lin

      Affiliations

    • Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Shou-Dong Lee

      Affiliations

    • Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

Received 30 June 2009; accepted 23 December 2009.

A 72-year-old female negative for hepatitis B surface antigen (HBsAg) and positive for antibody to hepatitis B surface antigen (anti-HBs) was diagnosed to have follicular lymphoma in 2006. Seventeen cycles of rituximab-based chemotherapy were administered over 23 months. Twelve days after the last cycle of chemotherapy, serum aminotransferase levels were elevated, and hepatitis serology tests revealed reappearance of HBsAg and hepatitis B e antigen (HBeAg), loss of anti-HBs, and positivity for hepatitis B virus (HBV) DNA. Antiviral treatment with entecavir was administered immediately, and the hepatitis flare was controlled. Rituximab-based chemotherapy can induce HBV reactivation even in HBsAg-negative, anti-HBs-positive patients. Early recognition and prompt antiviral treatment is crucial for patients with HBV reactivation during anticancer therapy.

Key Words:  anti-HBc positive , chemotherapy , HBV reactivation , non-Hodgkin's lymphoma , rituximab

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PII: S1726-4901(10)70031-9

doi:10.1016/S1726-4901(10)70031-9

Journal of the Chinese Medical Association
Volume 73, Issue 3 , Pages 156-160, March 2010

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