Beneficial effects of lamivudine on exacerbation of hepatitis due to immunosuppressive therapy for fulminant hepatitis in a patient with hepatitis B virus carrier

On May 1999, a 52-year-old man was admitted to our hospital with general fatigue and jaundice. He was diagnosed as a hepatitis B (HBV) carrier with fulminant hepatitis B based on severe liver dysfunction and hepatic coma. He was treated with plasma exchange (PE), hemo-dia-filtration (HDF) and was administered oral steroid following methyiprednisolone pulse therapy. After tapering steroid, he developed a flare-up of hepatitis. The balance between hepatic infection and immunoresponse to the virus is impaired during immunosuppressive therapy, leading to enhanced viral replication and an increased number of infected hepatocytes. Treatment with lamivudine was started, leading to a decrease in HBV-DNA to below the detectable limit and liver dysfunction improved. The overall survival rate of patients with fulminant hepatitis is reported to be 30% (acute type 50%, subacute type 25%). Therefore, lifesaving therapy with apheresis and high-dose immunosuppressive therapy was applied. HBV hepatitis exacerbated after immunosuppression. lamivudine was proven to be effective. It may be highly recommended for hepatitis B flare-up caused by reactivation of HBV.