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De novo hepatitis B infection in a HBsAg-negative patient with chronic lymphoproliferative disorder
HBV reactivation is becoming an important cause of morbidity and mortality in patients with hematologic malignancies undergoing chemotherapy, at highest risk being HBsAg positive patients (active or inactive chronic HBV infection). The occult carriers of HBV have a lower risk, but recent data reveal that reactivation risk is increasing and complications like fulminant hepatic failure and even death can occur. Pre-emptive antiviral therapy is the current standard for HBs Ag positive patients, but for occult carriers routine antiviral prophylaxis is recommended only in certain circumstances.
We report a case of „de novo“ hepatitis B in a patient with non-Hodgkin’s lymphoma and an unknown occult carrier status, which experienced viral reactivation after 5 month of combined fludarabine therapy. Lamivudine was initiated when HBs Ag seroreversion occurred and the outcome was good; she was then able to continue chemotherapy with rituximab-based regimen, maintaining antiviral treatment.
Keywords: screening, de-novo hepatitis B, occult HBV infection, lymphoma