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  • Title: Fulminant hepatic failure due to chemotherapy-induced hepatitis B reactivation: role of rituximab.
    Author: Stange MA, Tutarel O, Pischke S, Schneider A, Strassburg CP, Becker T, Barg-Hock H, Bastürk M, Wursthorn K, Cornberg M, Ott M, Greten TF, Manns MP, Wedemeyer H.
    Journal: Z Gastroenterol; 2010 Feb; 48(2):258-63. PubMed ID: 20127601.
    Abstract:
    Hepatitis B virus reactivation during immunosuppressive therapies can lead to liver failure with very limited treatment options available. We report here on two cases of severe hepatitis B reactivation during chemotherapy including rituximab for B cell lymphoma which were treated with liver or liver-cell transplantation. Liver function was normal and HBV infection was unknown in both patients before chemotherapy was started. Impaired liver function became apparent after 4 and 6 courses of chemotherapy, respectively, and both patients experienced fulminant hepatic failure despite antiviral treatment with lamivudine or entecavir. Patient A underwent liver transplantation after documentation of complete remission of the lymphoma and survived without any evidence for hepatitis B recurrence. Patient B received 4 courses of hepatocyte transplantation but did not survive. These cases underline the importance of anti-HBc screening in patients receiving immunosuppressive treatments in particular when rituximab is given. Pre-emptive antiviral treatments should be administered since delayed antiviral treatment is frequently unable to prevent liver failure.
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