Open AccessFatal liver failure due to reactivation of lamivudine-resistant HBV mutant
Author(s) -
Tatehiro Kagawa,
Norihito Watanabe,
Hisashi Kanouda,
Ichiro Takayama,
Tadahiko Shiba,
Takashi Kanai,
Kazuya Kawazoe,
Shinji Takashimizu,
Nobue Kumaki,
Kazuo Shimamura,
Shinya Matsuzaki,
Tetsuya Mine
Publication year - 2004
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v10.i11.1686
Subject(s) - lamivudine , medicine , cirrhosis , liver transplantation , gastroenterology , jaundice , hepatitis b , hepatitis b virus , virology , transplantation , virus
We report a case of fatal liver failure due to reactivation of lamivudine-resistant HBV. A 53-year-old man was followed since 1998 for HBV-related chronic hepatitis. Serum HBV-DNA was 150 MEq/mL (branched DNA signal amplification assay) and ALT levels fluctuated between 50-200 IU/L with no clinical signs of liver cirrhosis. Lamivudine (100 mg/d) was started in May 2001 and serum HBV-DNA subsequently decreased below undetectable levels. In May 2002, serum HBV-DNA had increased to 410 MEq/mL, along with ALT flare (226 IU/L). The YMDD motif in the DNA polymerase gene had been replaced by YIDD. Lamivudine was continued and ALT spontaneously decreased to the former levels. On Oct 3 the patient presenting with general fatigue, nausea and jaundice was admitted to our hospital. The laboratory data revealed HBV reactivation and liver failure (ALT: 1828 IU/L, total bilirubin: 10 mg/dL, and prothrombin INR: 3.24). For religious reasons, the patient and his family refused blood transfusion, plasma exchange and liver transplantation. The patient died 10 d after admission. The autopsy revealed remarkable liver atrophy.