Department of Infectious Diseases, Peking University First Hospital, Beijing, China.
Department of Infectious Diseases, Handan Central Hospital, Handan, China.
Front Immunol. 2022 Dec 2;13:1083862. doi: 10.3389/fimmu.2022.1083862. eCollection 2022.
A 72-year-old woman presented to our hospital with elevation of serum transaminases. Her blood tests showed the hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) negative. Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) were given for the diffuse large B-cell lymphoma. She didn't receive anti- hepatitis B virus (HBV) drug for the isolated HBcAb positive. HBV reactivation confirmed based on the serum HBV DNA detectable until 19 months after stopping R-CHOP regimen. HBV DNA became undetectable after 4 weeks therapy with Tenofovir alafenamide fumarate (TAF). Serum transaminases went down to normal 3 months later after receiving TAF. HBV reactivation is a substantial risk for patients with isolated HBcAb positive receiving rituximab-containing chemotherapy without anti- HBV drug. Regular monitoring with a frequency of 1-3 months is the basis for timely diagnosis and treatment of HBV reactivation. Serum transaminases abnormalities may be the initial manifestation of HBV reactivation.
一位 72 岁女性因血清转氨酶升高就诊于我院。其血液检查示乙型肝炎表面抗原（HBsAg）和乙型肝炎 e 抗原（HBeAg）阴性。给予利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）治疗弥漫性大 B 细胞淋巴瘤。因孤立的 HBcAb 阳性，她未接受抗乙型肝炎病毒（HBV）药物治疗。在停止 R-CHOP 方案后 19 个月时，基于血清 HBV DNA 可检测到，确认 HBV 再激活。接受富马酸替诺福韦酯艾拉酚胺（TAF）治疗 4 周后，HBV DNA 变为不可检测。接受 TAF 治疗 3 个月后，血清转氨酶恢复正常。对于接受含利妥昔单抗化疗而无抗 HBV 药物治疗的孤立 HBcAb 阳性患者，HBV 再激活是一个重大风险。定期监测（频率为 1-3 个月）是及时诊断和治疗 HBV 再激活的基础。血清转氨酶异常可能是 HBV 再激活的初始表现。
