Last update:
04-Jan-2001

Arch Hellen Med, 17(4), July-August 2000, 404-407

SHORT COMMUNICATION

Fulminant hepatitis B following chemotherapy

S.P. DOURAKIS,¹ E. ΤΖEMANAKIS,¹ A. KALOTERAKIS,¹
A. FILIOTOU,¹ G. KAFIRI,² S.J. HADZIYANNIS¹

¹Academic Department of Medicine
²Department of Pathology, Hippokration General Hospital, Athens, Greece

A case of a patient who developed fulminant hepatitis following chemotherapy for B-cell non-Hodgkin’s lymphoma is presented. The patient was anicteric before and during chemotherapy, with normal aminotransferase levels and was not tested for serological markers of hepatitis B virus (HBV) infection. Three weeks after the 6th course of CHOP chemotherapy, the patient became jaundiced with marked increase in serum aminotransferase levels. In the following days, he developed ascites, hepatic encephalopathy and prolongation of the prothrombin time. The diagnosis of acute exacerbation of chronic HBV infection was confirmed by an increase in the level of antibodies to the core antigen of HBV of IgM class (anti-HBc IgM) and the detection of HBV-DNA viremia by solution hybridization assay. He was unsuccessfully treated with steroids and died in hepatic coma. Nucleoside analogues were not available. In conclusion, patients who are going to receive chemotherapy should be screened for HBV infection and those who test positive carefully monitored for the development of acute exacerbation of chronic HBV infection.

Key words: Chemotherapy, Hepatitis, Hepatitis B virus, Non-Hodgkin’s lymphoma.