Reactivation of resolved hepatitis B virus infection with immune escape mutations after long-term corticosteroid therapy

Hepatitis B virus (HBV) reactivation from resolved infection is a serious problem which can frequently lead to severe hepatitis. Generally, it occurs several months after the start of immunosuppressive therapy; however, it sometimes occurs a few years later, even after cessation of therapy. Here we...

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Bibliographic Details
Published in:Clinical journal of gastroenterology 2016-04, Vol.9 (2), p.93-98
Main Authors: Inoue, Jun, Kondo, Yasuteru, Wakui, Yuta, Kogure, Takayuki, Morosawa, Tatsuki, Fujisaka, Yasuyuki, Umetsu, Teruyuki, Takai, Satoshi, Nakamura, Takuya, Shimosegawa, Tooru
Format: Article
Language:English
Subjects:
Abdominal Surgery
Adrenal Cortex Hormones - administration & dosage
Adrenal Cortex Hormones - adverse effects
Aged
Case Report
Colorectal Surgery
Drug Administration Schedule
Gastroenterology
Hepatitis B - immunology
Hepatitis B - virology
Hepatitis B virus - genetics
Hepatology
Humans
Immunosuppressive Agents - administration & dosage
Immunosuppressive Agents - adverse effects
Male
Medicine
Medicine & Public Health
Mutation
Pemphigus - drug therapy
Phylogeny
Surgical Oncology
Virus Activation
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Summary:Hepatitis B virus (HBV) reactivation from resolved infection is a serious problem which can frequently lead to severe hepatitis. Generally, it occurs several months after the start of immunosuppressive therapy; however, it sometimes occurs a few years later, even after cessation of therapy. Here we report a patient with de novo HBV infection who had received corticosteroid therapy for pemphigus vulgaris for 6 years. Full-genome HBV sequence analysis using serial serum samples revealed that the patient was infected with HBV subgenotype C2, which had the G1896R mixed mutation in the precore region. Interestingly, it had the immune escape mutations P120A and G145R in the S gene. Because both hepatitis B surface antigen and antibodies to hepatitis B surface antigen (HBsAb) were positive at the onset of the de novo infection, it was considered that HBV with these mutations escaped from neutralization by the pre-existing HBsAbs. This case indicates that HBV reactivation with an immune escape mutant can occur long after immunosuppressive therapy.
ISSN:1865-7257
1865-7265
DOI:10.1007/s12328-016-0631-1