Ito S, Nakazono K, Murasawa A, Mita Y, Hata K, Saito N, Kikuchi M, Yoshida K, Nakano M, Gejyo F
Department of Medicine II, Niigata University School of Medicine, Japan.
Arthritis Rheum. 2001 Feb;44(2):339-42. doi: 10.1002/1529-0131(200102)44:2<339::AID-ANR51>3.0.CO;2-Q.
A 75-year-old female rheumatoid arthritis patient who was positive for hepatitis B surface antigen and for antibodies to hepatitis Be antigen showed liver dysfunction, and therefore methotrexate (MTX) therapy was discontinued. Her drug lymphocyte stimulation test indicated positivity for MTX. Her liver dysfunction improved briefly, but she developed fulminant hepatitis with elevated levels of hepatitis B virus (HBV)/DNA polymerase and subsequently died. HBV/DNA analysis performed with polymerase chain reaction-mutation site-specific assay revealed that the fulminant hepatitis was caused by a precore mutant virus. Sudden reactivation of the immune system by discontinuation of MTX may have led to the attack on infected cells. Even when hepatitis Be antibodies are present, MTX should not be used in patients who have chronic infection with HBV.
一名75岁的类风湿性关节炎女性患者，乙肝表面抗原和乙肝e抗原抗体呈阳性，出现肝功能障碍，因此停用了甲氨蝶呤（MTX）治疗。她的药物淋巴细胞刺激试验显示对MTX呈阳性。她的肝功能障碍曾短暂改善，但随后出现暴发性肝炎，乙肝病毒（HBV）/DNA聚合酶水平升高，最终死亡。采用聚合酶链反应-突变位点特异性检测进行的HBV/DNA分析显示，暴发性肝炎是由前核心突变病毒引起的。停用MTX后免疫系统突然重新激活可能导致对受感染细胞的攻击。即使存在乙肝e抗体，也不应在慢性HBV感染患者中使用MTX。
