Letter to the EditorReactivation of resolved hepatitis B during rituximab therapy for rheumatoid arthritis
Introduction
Reactivation of the hepatitis B virus (HBV) is common in patients harboring the HBs antigen (AgHBs). To avoid this event, which can be life threatening during chemotherapy, preemptive treatment with nucleoside analogs should be given [1], [2]. Several studies in patients with a serological profile indicating resolved hepatitis B (AgHBs-negative, AcHBc-positive, and AcHBs-positive) point to a role for rituximab in HBV reactivation during combination chemotherapy for lymphoma [3], [4], [5], [6], [7], [8], [9].
Here, we report the first case of HBV reactivation in a patient with a serological profile of resolved hepatitis B who received rituximab therapy for rheumatoid arthritis (RA).
Section snippets
Case report
This patient was 78 years of age when he started rituximab therapy in 2007. In 1991, he had been diagnosed with RA, with rheumatoid factors and joint erosions. He was initially treated with methotrexate 20 mg/week and prednisone 5 mg/day. Infliximab was added subsequently to this regimen.
In June 2007, low-grade mantle B-cell lymphoma was diagnosed when a blood cell count showed 5400/mm3 lymphocytes with a typical immunophenotype. The lymphoma, combined with inadequate control of the joint disease
Discussion
We report the first case of reactivation during rituximab therapy of apparently resolved hepatitis B, in the absence of concomitant chemotherapy, in a patient with RA. Methotrexate discontinuation may have played a role, although the long time to reactivation does not support this possibility.
Routine transaminase monitoring ensured the diagnosis and allowed the prompt initiation of antiviral therapy. However, PCR detection of the HBV is preferable, as it provides an earlier diagnosis, which is
Disclosure of interest
The authors declare that they have no conflicts of interest concerning this article.
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