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Fatal Reactivation of Precore Mutant Hepatitis B Virus Associated with Fibrosing Cholestatic Hepatitis after Bone Marrow Transplantation
- Carolyn McIvor, FRACP;
- James Morton, MBBS;
- Andrew Bryant, FRACP;
- W. Graham Cooksley, FRACP;
- Simon Durrant, MRCP; and
- Neal Walker, FRACP
- From the Royal Brisbane Hospital, Brisbane, Queensland, Australia. Requests for Reprints: W. Graham Cooksley, MD, Clinical Research Centre, H Floor, Bancroft Center, Royal Brisbane Hospital, 300 Herston Road, Brisbane, Queensland 4029, Australia. Grant Support: In part by a Gastroenterological Society of Australia Medical Postgraduate Scholarship and by the Royal Brisbane Hospital Research Foundation.
Liver failure caused by reactivation of hepatitis B virus (HBV) is an uncommon complication of bone marrow transplantation [1-3]. Fibrosing cholestatic hepatitis is a recently described liver lesion that develops after liver transplantation for chronic HBV infection. Hepatitis B virus precore mutant infection has been associated with liver failure after cytotoxic chemotherapy [4] and with fibrosing cholestatic hepatitis after liver transplantation [5, 6], but the relation is unclear. We describe a patient who developed fibrosing cholestatic hepatitis and HBV precore mutant infection after bone marrow transplantation.
Case Report
A 49-year-old Chinese man had allogeneic bone marrow transplantation for acute myeloid leukemia. The patient had no history or clinical or biochemical evidence of liver disease. Before transplantation, the patient was positive for the hepatitis B surface antigen (HBsAg), negative for the hepatitis B e antigen (HBeAg), positive for the antibody to HBe (anti-HBe), positive for the antibody to hepatitis B core IgG (anti-HBc), and negative for the antibody to hepatitis B surface antigen (anti-HBs). Serology …
