Fatal reactivation of hepatitis B virus following cytotoxic chemotherapy for acute myelogenous leukemia: fibrosing cholestatic hepatitis

被引:14
作者
Kojima, H [1 ]
Abei, M
Takei, N
Mukai, Y
Hasegawa, Y
Iijima, T
Nagasawa, T
机构
[1] Univ Tsukuba, Inst Clin Med, Div Hematol, Tsukuba, Ibaraki 3058575, Japan
[2] Univ Tsukuba, Inst Clin Med, Div Gastroenterol, Tsukuba, Ibaraki 3058575, Japan
[3] Univ Tsukuba, Inst Basic Med Sci, Dept Pathol, Tsukuba, Ibaraki 3058575, Japan
关键词
hepatitis B virus; fibrosing cholestatic hepatitis; cytotoxic chemotherapy; lamivudine;
D O I
10.1034/j.1600-0609.2002.02719.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Hepatitis B virus (HBV) is a well known pathogen that sometimes causes fulminant hepatitis in patients undergoing cytotoxic chemotherapy. Fibrosing cholestatic hepatitis (FCH) is a recently recognized unique variant of viral hepatitis, which has been occasionally reported in HBV-infected recipients of liver, renal, or bone marrow transplantation. We present here a 48-yr-old male in whom HBV was reactivated during post-remission chemotherapy for acute myelogenous leukemia, which resulted in rapidly fatal outcome. He manifested with deterioration of liver function in association with enormous replication of HBV. Liver biopsy showed marked ballooning of hepatocytes, cholestasis, and periportal fibrosis with minimum infiltrates. Immunostaining revealed that hepatocytes were strongly positive for hepatitis B surface antigen. Under the diagnosis of FCH, he was treated with lamivudine and interferon beta, which was not effective. Autopsy showed severe atrophy of the liver and marked degeneration of hepatocytes. Hematologists should be aware that FCH is a fatal complication that can develop under post-chemotherapy immunosuppressed conditions. Although there is no convincing evidence, prophylactic administration of lamivudine seems to be a reasonable strategy.
引用
收藏
页码:101 / 104
页数:4
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