Abstract
Introduction: Hepatitis B virus (HBV) surface-antigen mutants can present diagnostic difficulties when they are not recognized by commercial assays; HBV infection with undetectable core antibody is also described. Case presentation: We report the case of a multiple myeloma patient who had no detectable serum HBV core antibody, HBV surface antigen (HBsAg) or HBV DNA prior to immunosuppressive treatment, who, after autologous stem-cell transplant, developed a reactivation of occult HBV with a HBsAg mutant, undetectable with a commercial HBsAg assay. Conclusion: This case reminds clinicians to be mindful of the potential diagnostic difficulties of HBV serology in the immunosuppressed, and to remain vigilant for the possibility of the reactivation of HBV and the existence of HBsAg mutants, which can also reactivate, in the context of profound immunosuppression.
Highlights
Hepatitis B virus (HBV) surface-antigen mutants can present diagnostic difficulties when they are not recognized by commercial assays; hepatitis B virus (HBV) infection with undetectable core antibody is described.Case presentation: We report the case of a multiple myeloma patient who had no detectable serum HBV core antibody, HBV surface antigen (HBsAg) or HBV DNA prior to immunosuppressive treatment, who, after autologous stem-cell transplant, developed a reactivation of occult HBV with a HBsAg mutant, undetectable with a commercial HBsAg assay
The natural history of HBV infection depends on the host immune response and can result in either resolution or chronic infection
Chronic infection is usually defined as persistence of HBV surface antigen (HBsAg) in serum for greater than 6 months
Summary
Chronic hepatitis B virus (HBV) infection is a major public health problem worldwide; over 350 million people are chronically infected, with an estimated one-third of the global population showing serological evidence of past infection (Liaw & Chu, 2009). We present a report of a multiple myeloma patient who had no detectable serum anti-HBc, HBsAg or HBV DNA prior to immunosuppressive treatment, who, after an autologous stem-cell transplant, appeared to reactivate an occult HBV infection with an HBsAg mutant that was undetectable with a commercial HBsAg assay. Test results were negative for HBsAg (Siemens Centaur XP) anti-HBc (Siemens Centaur XP), as well as for hepatitis C virus antibodies and for human immunodeficiency virus p24 antigen and antibodies (Siemens Centaur XP) He underwent chemotherapy with eight cycles of cyclophosphamide, thalidomide and dexamethasone from July 2010 to January 2011, before undergoing a high-dose melphalan autologous stem-cell transplant in April 2011, with a significant improvement in his serum light-chain levels. He had no other risk factors for HBV exposure at the time of the transplant when HBsAg was detected
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