Successful use of entecavir for a severe case of reactivation of hepatitis B virus following polychemotherapy containing rituximab.

Backgrounds/aims: Hepatitis B virus (HBV) reactivation following treatment with rituximab has been reported in patients with either HBsAg-positive, or HBsAg-negative and anti-HBc positive infection. Patients with severe reactivation often have a fatal outcome despite treatment with lamivudine. The use of entecavir has not been reported in patients with severe HBV reactivation.

Methods: We present a case of a HBsAg-negative patient diagnosed with chronic lymphocytic leukemia who received a chemotherapeutic regimen that included rituximab, who subsequently presented with severe HBV reactivation with ascites, jaundice and coagulopathy and was treated with entecavir. A review of the literature and underlying HBV associated mutations are discussed.

Results: Entecavir produced a rapid and sustained suppression of HBV that was associated with rapid clinical improvement without any side effects.

Conclusion: Entecavir is an efficacious and safe treatment for severe HBV reactivation.