Fulminant hepatitis caused by a hepatitis B virus core region variant strain.

We studied the viral genome of a hepatitis B viral strain isolated from a patient with fulminant hepatitis. The patient was followed from prior to the rise in transaminases until she recovered. The precore and core regions of the viral strains were sequenced before and after the illness via the polymerase chain reaction and subcloning methods. Prior to her clinical illness, a strain with precore wild-type sequence and core mutations corresponding to amino acid residues 77 and 113 was noted in large quantities. With the onset of hepatitis, this core variant completely disappeared. Very low titers of precore and core wild or partial core deletion strains remained 1 month later. The core variants described may have contributed to the severe host immune reaction, fulminant hepatitis and immune-mediated viral clearance. Such variants appeared to have been eliminated, and wild and core-deleted virus that lacked the peculiar mutations remained.