Acute hepatitis B virus infection with delayed appearance of hepatitis B core antibody in an immunocompromised patient: a case report
Author(s)
Type
Journal Article
Abstract
BACKGROUND: Despite the introduction of universal hepatitis B immunization programs worldwide, outbreaks of acute infection still occur in unimmunized individuals. A timely diagnosis of hepatitis B is necessary to ensure adequate clinical care and public health interventions that will reduce transmission. Yet, interpretation of hepatitis B serological markers can be complex. We present a case of hepatitis B with atypical markers, including delayed appearance of hepatitis B core antibody. CASE PRESENTATION: A 62-year-old white woman was identified as a sexual contact of a male individual with acute hepatitis B virus infection. She had a history of recurrent low-grade non-Hodgkin lymphoma and had recently received immunosuppressive therapy. At baseline she had a negative serology and received three double doses (40 μg) of Engerix-B vaccine (hepatitis B vaccine) with a 0-month, 1-month, and 6-month schedule. One month following the last dose, hepatitis B surface antigen was positive in the absence of hepatitis B core antibody. The only sign of infection was a slight elevation of alanine aminotransferase enzymes a few months after first sexual contacts with the male individual. Hepatitis B virus infection was later confirmed despite the absence of hepatitis B core antibody. The development of hepatitis B core antibody was finally noted more than 6 months after the first positive hepatitis B surface antigen and more than 12 months after elevation of alanine aminotransferase enzymes. Immunosuppression including rituximab treatment was the most likely explanation for this serological profile. On her last medical assessment, she had not developed HBeAg seroconversion despite lower hepatitis B virus deoxyribonucleic acid levels with tenofovir treatment. CONCLUSIONS: When confronted with positive hepatitis B surface antigen in the absence of hepatitis B core antibody, consideration should be given to the possibility of both acute and persistent infection particularly in the setting of immunosuppression so that appropriate clinical management and public health interventions can take place. Given the increasing use of biologicals such as anti-tumor necrosis factor therapies either alone or with other immunosuppressive agents, this phenomenon may be encountered more frequently.
Date Issued
2017-04-17
Date Acceptance
2017-03-09
Citation
Journal of Medical Case Reports, 2017, 11 (1)
ISSN
1752-1947
Publisher
BioMed Central
Journal / Book Title
Journal of Medical Case Reports
Volume
11
Issue
1
Copyright Statement
© The Author(s). 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/28412974
PII: 10.1186/s13256-017-1264-9
Subjects
Anti-HBc
HBsAg
Hepatitis B virus infection
Immunosuppression
Rituximab
Antiviral Agents
Contact Tracing
Female
Hepatitis B
Hepatitis B Antibodies
Hepatitis B virus
Humans
Immunocompromised Host
Immunosuppressive Agents
Lymphoma, Non-Hodgkin
Middle Aged
Rituximab
Tenofovir
Treatment Outcome
Publication Status
Published
Coverage Spatial
England
Article Number
ARTN 111
Date Publish Online
2017-04-17