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Hepatitis B virus (HBV) surface-antigen mutants can present diagnostic difficulties when they are not recognized by commercial assays; HBV infection with undetectable core antibody is also described.Case presentation:We report the case of a multiple myeloma patient who had no detectable serum HBV core antibody, HBV surface antigen (HBsAg) or HBV DNA prior to immunosuppressive treatment, who, after autologous stem-cell transplant, developed a reactivation of occult HBV with a HBsAg mutant, undetectable with a commercial HBsAg assay.Conclusion:This case reminds clinicians to be mindful of the potential diagnostic difficulties of HBV serology in the immunosuppressed, and to remain vigilant for the possibility of the reactivation of HBV and the existence of HBsAg mutants, which can also reactivate, in the context of profound immunosuppression.

jmm case reports

Reactivation of a hepatitis B virus surface-antigen mutant following an autologous stem-cell transplant for multiple myeloma in an anti-HBc-negative patient