1887

Abstract

Introduction:

Hepatitis B virus (HBV) surface-antigen mutants can present diagnostic difficulties when they are not recognized by commercial assays; HBV infection with undetectable core antibody is also described.

Case presentation:

We report the case of a multiple myeloma patient who had no detectable serum HBV core antibody, HBV surface antigen (HBsAg) or HBV DNA prior to immunosuppressive treatment, who, after autologous stem-cell transplant, developed a reactivation of occult HBV with a HBsAg mutant, undetectable with a commercial HBsAg assay.

Conclusion:

This case reminds clinicians to be mindful of the potential diagnostic difficulties of HBV serology in the immunosuppressed, and to remain vigilant for the possibility of the reactivation of HBV and the existence of HBsAg mutants, which can also reactivate, in the context of profound immunosuppression.

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2015-06-01
2019-08-23
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References

  1. Alavian S.M , Carman W.F , Jazayeri S.M . 2013; HBsAg variants: diagnostic-escape and diagnostic dilemma. J Clin Virol 57: 201– 208 [CrossRef] [PubMed]
    [Google Scholar]
  2. Avettand-Fenoel V , Thabut D , Katlama C , Poynard T , Thibault V . 2006; Immune suppression as the etiology of failure to detect anti-HBc antibodies in patients with chronic hepatitis B virus infection. J Clin Microbiol 44: 2250– 2253 [CrossRef] [PubMed]
    [Google Scholar]
  3. Awerkiew S , Däumer M , Reiser M , Wend U.C , Pfister H , Kaiser R , Willems W.R , Gerlich W.H . 2007; Reactivation of an occult hepatitis B virus escape mutant in an anti-HBs positive, anti-HBc negative lymphoma patient. J Clin Virol 38: 83– 86 [CrossRef] [PubMed]
    [Google Scholar]
  4. Baclig M.O , Alvarez M.R , Gopez-Cervantes J , Natividad F.F . 2014; Unique surface gene variants of hepatitis B virus isolated from patients in the Philippines. J Med Virol 86: 209– 216 [CrossRef] [PubMed]
    [Google Scholar]
  5. Carman W.F , Karayiannis P , Waters J , Thomas H.C , Zanetti A.R , Manzillo G , Zuckerman A.J . 1990; Vaccine-induced escape mutant of hepatitis B virus. Lancet 336: 325– 329 [CrossRef] [PubMed]
    [Google Scholar]
  6. European Association for the Study of the Liver 2012; EASL Clinical Practice Guidelines: management of chronic hepatitis B virus infection. J Hepatol 57: 167– 185 [CrossRef] [PubMed]
    [Google Scholar]
  7. Feeney S.A , McCaughey C , Watt A.P , Agnaf M.R , McDougall N , Wend U.C , Gerlich W.H , Coyle P.V . 2013; Reactivation of occult hepatitis B virus infection following cytotoxic lymphoma therapy in an anti-HBc negative patient. J Med Virol 85: 597– 601 [CrossRef] [PubMed]
    [Google Scholar]
  8. Ghany M.G , Ayola B , Villamil F.G , Gish R.G , Rojter S , Vierling J.M , Lok A.S . 1998; Hepatitis B virus S mutants in liver transplant recipients who were reinfected despite hepatitis B immune globulin prophylaxis. Hepatology 27: 213– 222 [CrossRef] [PubMed]
    [Google Scholar]
  9. Kantelhardt V.C , Schwarz A , Wend U , Schüttler C.G , Willems W.R , Trimoulet P , Fleury H , Gerlich W.H , Kann M . 2009; Re-evaluation of anti-HBc non-reactive serum samples from patients with persistent hepatitis B infection by immune precipitation with labelled HBV core antigen. J Clin Virol 46: 124– 128 [CrossRef] [PubMed]
    [Google Scholar]
  10. Liaw Y.F , Chu C.M . 2009; Hepatitis B virus infection. Lancet 373: 582– 592 [CrossRef] [PubMed]
    [Google Scholar]
  11. Raimondo G , Allain J.P , Brunetto M.R , Buendia M.A , Chen D.S , Colombo M , Craxì A , Donato F , Ferrari C , other authors . 2008; Statements from the Taormina expert meeting on occult hepatitis B virus infection. J Hepatol 49: 652– 657 [CrossRef] [PubMed]
    [Google Scholar]
  12. Sera T , Hiasa Y , Michitaka K , Konishi I , Matsuura K , Tokumoto Y , Matsuura B , Kajiwara T , Masumoto T , other authors . 2006; Anti-HBs-positive liver failure due to hepatitis B virus reactivation induced by rituximab. Intern Med 45: 721– 724 [CrossRef] [PubMed]
    [Google Scholar]
  13. Weber B . 2005; Genetic variability of the S gene of hepatitis B virus: clinical and diagnostic impact. J Clin Virol 32: 102– 112 [CrossRef] [PubMed]
    [Google Scholar]
  14. Westhoff T.H , Jochimsen F , Schmittel A , Stöffler-Meilicke M , Schäfer J.H , Zidek W , Gerlich W.H , Thiel E . 2003; Fatal hepatitis B virus reactivation by an escape mutant following rituximab therapy. Blood 102: 1930 [CrossRef]
    [Google Scholar]
  15. Zoulim F , Zhang X , Pichoud C , Trepo C . 1996; Heterogeneity of hepatitis B virus (HBV) core gene in a patient with HBV-associated cirrhosis and serum negativity for anti-HBc. J Hepatol 24: 155– 160 [CrossRef] [PubMed]
    [Google Scholar]
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