Successful Treatment with Adefovir of One Patient Whose Cryoglobulinemic Vasculitis Relapsed under Lamivudine Therapy and Who was Diagnosed to Have HBV Virologic Breakthrough with YMDD Mutations

• Published in: Internal Medicine Vol. 45; no. 21; pp. 1213 - 1215
• Main Authors: Çakir, Necati, Pamuk, Ömer Nuri, Ümit, Hasan, Midilli, Kenan
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01-01-2006
• Subjects: Adefovir; Adenine - analogs & derivatives; Adenine - therapeutic use; Amino Acid Motifs - genetics; Aspartic Acid - genetics; Cryoglobulinemia - diagnosis; Cryoglobulinemia - drug therapy; Cryoglobulinemia - genetics; cryoglobulinemic; DNA-directed DNA polymerase; Female; Hepatitis; Hepatitis B - diagnosis; Hepatitis B - drug therapy; Hepatitis B - genetics; Hepatitis B virus; Hepatitis B virus - genetics; Humans; Lamivudine; Lamivudine - therapeutic use; Methionine - genetics; Middle Aged; Mutation; Organophosphonates - therapeutic use; Purpura; Recurrence; Tyrosine - genetics; Vasculitis; Vasculitis - diagnosis; Vasculitis - drug therapy; Vasculitis - genetics; YMDD motif mutant
• ISSN: 0918-2918; 1349-7235; 1349-7235
• DOI: 10.2169/internalmedicine.45.1816

We report a patient whose cryoglobulinemic vasculitis recurred due to reactivation of lamivudine-resistant HBV. Our patient with hepatitis B-related cryoglobulinemic vasculitis was administered lamivudine. Her vasculitis regressed, ALT normalized, HBV-DNA became negative. Under lamivudine therapy, her cryoglobulinemic cutaneous vasculitis recurred. ALT increased significantly; it was found that tyrosine-methionine-aspartate-aspartate (YMDD) motif in the DNA polymerase gene had been replaced by YIDD. Adefovir was added to lamivudine. During follow-up, her purpura disappeared, ALT normalized, HBV-DNA became negative. Our patient is the first whose cryoglobulinemic vasculitis recurred under lamivudine, who had a HBV virologic breakthrough with YMDD mutation, and was successfully treated with adefovir.