Anti-HBs-positive liver failure due to hepatitis B virus reactivation induced by rituximab

Intern Med. 2006;45(11):721-4. doi: 10.2169/internalmedicine.45.1590. Epub 2006 Jul 3.

Abstract

A 59-year-old man developed acute hepatitis with reactivated hepatitis B virus (HBV) following administration of rituximab (anti-CD20 monoclonal antibody). The patient was diagnosed with malignant lymphoma in 1998, and virus marker testing indicated HBV surface antigen (HBsAg)-negative and anti-HBs antibody (anti-HBs)-positive results when chemotherapy including rituximab was started. Levels of aminotransferases were elevated, and HBsAg results turned positive. Despite therapy for late-onset hepatic failure, the patient died. Rituximab appears likely to have induced HBV reactivation in this case. Anti-viral agents should be administered for both HBsAg-positive and anti-HBs-positive patients who are scheduled to receive rituximab.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Murine-Derived
  • Antiviral Agents / therapeutic use
  • Hepatitis B / blood
  • Hepatitis B / chemically induced*
  • Hepatitis B / complications
  • Hepatitis B Antibodies / blood*
  • Hepatitis B Surface Antigens / blood
  • Hepatitis B virus / drug effects
  • Hepatitis B virus / immunology
  • Hepatitis B virus / physiology*
  • Humans
  • Immunologic Factors / adverse effects*
  • Immunologic Factors / therapeutic use
  • Liver Failure / blood
  • Liver Failure / immunology*
  • Liver Failure / prevention & control
  • Lymphoma / drug therapy
  • Male
  • Middle Aged
  • Rituximab
  • Transaminases / blood

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Antiviral Agents
  • Hepatitis B Antibodies
  • Hepatitis B Surface Antigens
  • Immunologic Factors
  • Rituximab
  • Transaminases