Alpha-fetoprotein in hepatitis superimposed on cirrhosis: a case of concomitant hepatitis B surface antigen and antibody associated with a major but transient increase in the alpha-fetoprotein level.

A 53-year-old man with hepatitis concurrent with cirrhosis was simultaneously positive for hepatitis B surface antigen and heterotypic anti HBs antibody. This could be explained by a state of tolerance, with chronic carrying of B virus (subtype a y w3), but would not preclude B virus (subtype d) reinfection, inducing the synthesis of specific anti-d antibodies. In the same patient, the very high level of 3460 ng/ml was reached for alpha-fetoprotein; this was transitory and returned to normal within 8 months; it was probably due to the acute hepatitis. Thus it appears that, even in cases of cirrhosis, a major rise in this marker does not absolutely imply the presence of hepatocellular carcinoma.