Ye Yun, Xie Jing, Wang Lina, He Cong, Tan Youwen
Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang 212003, Jiangsu Province, China.
Open Med (Wars). 2023 Mar 30;18(1):20230693. doi: 10.1515/med-2023-0693. eCollection 2023.
Chronic hepatitis B (CHB) often causes iron overload in the liver but rarely causes severe secondary hemochromatosis (SH). A 48-year-old man was infected with CHB via vertical transmission. For 21 years, nonstandard treatment with second-line hepatitis B antiviral drugs has been administered. Repeated abnormalities in the liver transaminase function and continuous low-level replication of the hepatitis B virus (HBV) have been detected. The skin had turned black 5 years back. Biochemical tests and imaging revealed the presence of hemochromatosis. A liver biopsy suggested severe iron overload. Two genetic tests ruled out hereditary hemochromatosis. The patient was diagnosed with SH and treated with 400 ml bloodletting once per week and an iron-chelating agent. After 12 weeks, liver function was normal, and the skin turned white. First, hepatitis B surface antigen (HBsAg) was lost, and HBV DNA was copied at low levels. The patient was diagnosed with an occult hepatitis B infection. HBV DNA was undetectable after 4 weeks of antiviral treatment with tenofovir. Upon reviewing the patient's medical history, hemochromatosis was believed to be related to CHB with chronic inflammatory damage and no complete virological response. Improvements in hemochromatosis may promote HBsAg disappearance.
慢性乙型肝炎（CHB）常导致肝脏铁过载，但很少引起严重的继发性血色素沉着症（SH）。一名48岁男性通过垂直传播感染了CHB。21年来，一直使用二线乙肝抗病毒药物进行不规范治疗。检测到肝转氨酶功能反复异常以及乙肝病毒（HBV）持续低水平复制。5年前皮肤变黑。生化检查和影像学检查显示存在血色素沉着症。肝脏活检提示严重铁过载。两项基因检测排除了遗传性血色素沉着症。该患者被诊断为SH，并接受每周一次400毫升放血及铁螯合剂治疗。12周后，肝功能恢复正常，皮肤变白。首先，乙肝表面抗原（HBsAg）消失，HBV DNA呈低水平复制。该患者被诊断为隐匿性乙型肝炎感染。使用替诺福韦进行抗病毒治疗4周后，HBV DNA检测不到。回顾患者病史，血色素沉着症被认为与CHB伴慢性炎症损伤且无完全病毒学应答有关。血色素沉着症的改善可能促进HBsAg消失。
