Fatal liver failure due to reactivation of lamivudine-resistant HBV mutant

We report a case of fatal liver failure due to reactivation of lamivudine-resistant HBV. A 53-year-old man was followed since 1998 for HBV-related chronic hepatitis. Serum HBV-DNA was 150 MEq/mL (branched DNA signal amplification assay) and ALT levels fluctuated between 50-200 IU/L with no clinical...

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Published in:	World journal of gastroenterology : WJG Vol. 10; no. 11; pp. 1686 - 1687
Main Authors:	Kagawa, Tatehiro, Watanabe, Norihito, Kanouda, Hisashi, Takayama, Ichiro, Shiba, Tadahiko, Kanai, Takashi, Kawazoe, Kazuya, Takashimizu, Shinji, Kumaki, Nobue, Shimamura, Kazuo, Matsuzaki, Shohei, Mine, Tetsuya
Format:	Journal Article
Language:	English
Published:	United States Department of Internal Medicine,Tokai University School of Medicine,Boseidai,Isehara,Kanagawa 259-1193,Japan%Department of Pathology,Tokai University School of Medicine,Boseidai,Isehara,Kanagawa 259-1193,Japan 01-06-2004 Baishideng Publishing Group Inc
Subjects:	Case Report Drug Resistance, Viral - genetics Fatal Outcome HBV Hepatitis B virus - drug effects Hepatitis B virus - genetics Hepatitis B, Chronic - drug therapy Hepatitis B, Chronic - pathology Hepatitis B, Chronic - virology Humans Lamivudine - therapeutic use Male Middle Aged Mutation Recurrence Reverse Transcriptase Inhibitors - therapeutic use 免疫能力基因突变肝硬变肝细胞再生
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Summary:	We report a case of fatal liver failure due to reactivation of lamivudine-resistant HBV. A 53-year-old man was followed since 1998 for HBV-related chronic hepatitis. Serum HBV-DNA was 150 MEq/mL (branched DNA signal amplification assay) and ALT levels fluctuated between 50-200 IU/L with no clinical signs of liver cirrhosis. Lamivudine (100 mg/d) was started in May 2001 and serum HBV-DNA subsequently decreased below undetectable levels. In May 2002, serum HBV-DNA had increased to 410 MEq/mL, along with ALT flare (226 IU/L). The YMDD motif in the DNA polymerase gene had been replaced by YIDD. Lamivudine was continued and ALT spontaneously decreased to the former levels. On Oct 3 the patient presenting with general fatigue, nausea and jaundice was admitted to our hospital. The laboratory data revealed HBV reactivation and liver failure (ALT: 1828 IU/L, total bilirubin: 10 mg/dL, and prothrombin INR: 3.24). For religious reasons, the patient and his family refused blood transfusion, plasma exchange and liver transplantation. The patient died 10 d after admission. The autopsy revealed remarkable liver atrophy.
Bibliography:	14-1219/R R575 R512.62 ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3 Telephone: +81-463-931121 Correspondence to: Dr. Tatehiro Kagawa, Department of Internal Medicine, Tokai University School of Medicine, Boseidai, Isehara, Kanagawa 259-1193, Japan. kagawa@is.icc.u-tokai.ac.jp Author contributions: All authors contributed equally to the work.
ISSN:	1007-9327 2219-2840
DOI:	10.3748/wjg.v10.i11.1686