Spontaneous hepatitis B surface antigen seroconversion after long lasting hepatitis B virus infection in a chronic hemodialysis patient

Abstract

Aim: The aim was to present an unusual spontaneous disappearance of HBsAg after a long-lasting infection. Case report: A 26-year-old man started chronic hemodialysis (HD) in 1994 for chronic glomerulonephritis. Serological analysis was positive for hepatitis B virus (HBV) infection. During the following years he was treated with HD and his HBV markers remained unchanged (HBsAg positivity). When antiviral therapy became available the patient refused to be treated. In 2006 his HBsAg became negative for the first time in 12 years, while anti-HBs and anti-HBc became positive, which would indicate that he became immune late after a natural infection. To date, all repeated check-ups have been negative for HBsAg. In 2008 he received a kidney transplant from a deceased donor and was put on immunosuppressive (IS) therapy. During the IS treatment, which is ongoing, he has been stable and without HBV viremia (HBsAg-negative). Conclusion: It has still remained unclear how spontaneous HBsAg seroconversion did happen in our patient after long lasting infection. It has also been interesting that 11 years after seroconversion his HBV markers have still been unchanged (HBsAg negativity) and show signs of a resolved HBV infection, even though he has been immunosuppressed due to kidney transplantation for already 9 years. It is possible that his anti-HBs levels are high enough to protect him and inhibit HBV reactivation or the virus has not been dormant in his hepatic cells at all.