%0 Journal Article
%T Hepatitis B Virus Reactivation Induced by Infliximab Administration in a Patient with Crohn¡¯s Disease
%A Yuka Miyake
%A Aki Hasebe
%A Tetsuya Tanihira
%A Akiko Shiraishi
%A Yusuke Imai
%A Haruka Tatsukawa
%A Hiroka Yamago
%A Hiromasa Nakahara
%A Yuko Shimizu
%A Keiko Ninomiya
%A Atsushi Hiraoka
%A Hideki Miyata
%A Tomoyuki Ninomiya
%A Kojiro Michitaka
%J Case Reports in Hepatology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/461879
%X A 47-year-old man diagnosed with Crohn¡¯s disease was treated with infliximab. He tested negative for hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs) but positive for anti-HB core antibody (anti-HBc). He tested positive for hepatitis B virus (HBV-) DNA 3 months after treatment and was administered entecavir. HBV-DNA test showed negative results 1 month later. ALT was persistently within the normal range, and HBV-DNA was persistently negative thereafter despite the continuation of infliximab every 8 weeks. In our hospital, 14 patients with inflammatory bowel disease, who tested negative for HBsAg, were treated with infliximab; 2 of them tested positive for anti-HBs and/or anti-HBc, and HBV reactivation was observed in 1 patient (the present patient). The present case and these findings highlight that careful follow-up is needed in patients with inflammatory bowel disease treated with infliximab who test positive for anti-HBc and/or anti-HBs. 1. Introduction Crohn¡¯s disease is a chronic and intractable inflammatory disorder of the gastrointestinal tract [1]. Many types of therapy have been introduced to treat Crohn¡¯s disease, such as nutritional therapy, 5-aminosalicylic acid drugs, corticosteroids, azathioprine, and 6-mercaptopurine [2¨C6]. Monoclonal antibodies against tumor necrosis factor alpha (anti-TNF¦Á), such as infliximab and adalimumab, have recently been used to treat inflammatory bowel disease [7¨C9]. Short- and long-term anti-TNF-¦Á therapies in Crohn¡¯s disease are generally well tolerated. However, clinicians must be vigilant for the occurrence of infrequent but serious events [10]. Immunosuppressive therapy may induce the reactivation of hepatitis B virus (HBV), not only in patients in an inactive hepatitis B surface antigen (HBsAg) carrier state, but, in resolved patients as well. HBV reactivation in HBV-resolved patients may cause hepatitis (i.e., de novo hepatitis). Moreover, hepatitis B reactivation due to immunosuppressive therapy sometimes progresses to severe hepatitis, and several fatal cases have been reported [11, 12]. Here, we report the case of a patient with Crohn¡¯s disease who tested negative for HBsAg and positive for anti-HB core antibody (anti-HBc) and exhibited HBV reactivation during treatment with anti-TNF-¦Á antibody (infliximab). 2. Case Report A 47-year-old man, with a history of abdominal operations because of perforation of the ileum and ileus in 2000 and 2001, respectively, and diagnosed with Crohn¡¯s disease histologically in 2000, was admitted to our hospital because of abdominal pain. He
%U http://www.hindawi.com/journals/crihep/2013/461879/