Wasmuth J-C, Fischer H-P, Sauerbruch T, Dumoulin F L
Department of Internal Medicine I, University Hospital of Bonn, Germany.
Eur J Med Res. 2008 Oct 27;13(10):483-6.
Reactivation of chronic hepatitis B in HBsAg carriers is a well known complication of chemo?therapy. The clinical spectrum ranges from asymptomatic hepatitis to fatal hepatic failure. Although it impairs the prognosis of cancer treatment, it may be overlooked due to other possible causes of liver damage.
The patient presented with acute liver failure after 6 cycles of rituximab, fludarabine, and cyclophosphamide for low grade non-hodgkin's lymphoma. Differential diagnoses were chemotherapy-induced liver failure, autoimmune hepatitis, phenprocoumon-induced liver failure and infiltration of the liver by lymphoma. Finally, reactivation of hepatitis B with a fibrosing cholestatic pattern was identified.
This case reminds clinicians that patients receiving high-intensive chemotherapy or immunosuppressive therapy should be screened for HBsAg. HbsAg positive patients should obtain prophylactic antiviral therapy with lamivudine or another substance active against HBV.
乙肝表面抗原（HBsAg）携带者慢性乙型肝炎的再激活是化疗众所周知的并发症。临床谱从无症状性肝炎到致命性肝衰竭。尽管它会损害癌症治疗的预后，但由于其他可能的肝损伤原因，它可能被忽视。
该患者在接受6个周期的利妥昔单抗、氟达拉滨和环磷酰胺治疗低度非霍奇金淋巴瘤后出现急性肝衰竭。鉴别诊断包括化疗引起的肝衰竭、自身免疫性肝炎、苯丙香豆素引起的肝衰竭以及淋巴瘤肝脏浸润。最后，确定为伴有纤维化胆汁淤积型的乙型肝炎再激活。
该病例提醒临床医生，接受高强度化疗或免疫抑制治疗的患者应筛查HBsAg。HBsAg阳性患者应接受拉米夫定或其他抗乙肝病毒活性物质的预防性抗病毒治疗。
