Development of de novo hepatitis B in patient during follow-up of liver-graft-versus-host disease associated with allogeneic peripheral blood stem cell transplantation

Yosuke Michikawa, Hiroki Ikeda, Chiaki Okuse, Miki Okano, Ryuta Shigefuku, Nobuhiro Hattori, Moriaki Hatsugai, Hideaki Takahashi, Kotaro Matsunaga, Tsunamasa Watanabe, Nobuyuki Matsumoto, Hiroshi Yotsuyanagi, Michihiro Suzuki, Fumio Itoh


A 66-year-old female patient with acute myeloid leukemia underwent remission-induction therapy and allogeneic peripheralstem cell transplantation. The patient was found to have a resolved hepatitis B virus (HBV) infection, as shown by her positivityfor the hepatitis B surface (HBs) antibody and hepatitis B core antibody and negativity for the HBs antigen and HBV-DNA. Administration of an immunosuppressant was started after transplantation for the prevention of graft-versus-host disease (GVHD), and hepatic impairment developed four months after transplantation. No changes were observed in serum HBV-related markerlevels, and a liver biopsy revealed GVHD. The course of hepatic impairment was followed up with the diagnosis of liverGVHD, without determining the level of HBV-related markers. Hepatic impairment recurred 13 months after transplantation. Determination of the HBV-related markers showed that the patient was positive for the HBs antigen and HBV-DNA. The patientwas diagnosed as having de novo hepatitis B, and the hepatitis improved after the start of anti-viral therapy. In administering immunosuppressive therapy and chemotherapy for patients with a resolved HBV infection, it is important to test for viral markersregularly by paying constant attention to the possible onset of de novo hepatitis B, despite the existing hepatic disease.

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Case Reports in Internal Medicine

ISSN 2332-7243(Print)  ISSN 2332-7251(Online)

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