Submassive liver necrosis in a hepatitis B carrier with Cushing's syndrome.

Reactivation of hepatitis B virus (HBV) replication in hepatitis B surface antigen (HBsAg)-positive patients is associated with immunosuppressive therapy. However, the interactions between endogenous glucocorticoid in Cushing's syndrome and HBV-related hepatitis remain unclear. Here, we describe the management of a 32-year-old male HBV carrier with Cushing's syndrome caused by an adrenal cortical adenoma, who developed severe hepatitis B. Repeated episodes of septicemia resulting from hypercortisolemia-related immunosuppression further compromised his hepatic condition. Adrenalectomy could not be performed due to coagulopathy. Lamivudine was not available at that time in Taiwan, and this patient died of hepatic failure and sepsis. At autopsy, his liver showed submassive necrosis with small regenerative nodules. The hepatocytes were positive for HBsAg (membrane and cytoplasmic) and hepatitis B core antigen (nuclear and cytoplasmic). Screening for HBsAg is of crucial significance for immunocompromised individuals. Once positive HBsAg is detected in immunosuppressed patients, liver function and viral status should be closely monitored to enable earlier diagnosis and prompt treatment with the newer nucleoside analogues that actively fight HBV.

[1]  N. Terrault,et al.  Lamivudine treatment is beneficial in patients with severely decompensated cirrhosis and actively replicating hepatitis B infection awaiting liver transplantation: A comparative study using a matched, untreated cohort , 2001, Hepatology.

[2]  W. Yang,et al.  RESULTS ON PREEMPTIVE OR PROPHYLACTIC TREATMENT OF LAMIVUDINE IN HBsAg (+) RENAL ALLOGRAFT RECIPIENTS: COMPARISON WITH SALVAGE TREATMENT AFTER HEPATIC DYSFUNCTION WITH HBV RECURRENCE , 2001, Transplantation.

[3]  T. Koike,et al.  A possible role for lamivudine as prophylaxis against hepatitis B reactivation in carriers of hepatitis B who undergo chemotherapy and autologous peripheral blood stem cell transplantation for non-Hodgkin's lymphoma , 2001, Bone Marrow Transplantation.

[4]  W. Wilson,et al.  Reactivation of chronic hepatitis B infection following intensive chemotherapy and successful treatment with lamivudine: a case report and review of the literature. , 2001, Annals of oncology : official journal of the European Society for Medical Oncology.

[5]  J. Kobashigawa,et al.  Successful use of lamivudine for severe acute hepatitis B virus infection in a cardiac transplant recipient. , 1999, Transplantation.

[6]  D. V. van Thiel,et al.  Lamivudine treatment of advanced and decompensated liver disease due to hepatitis B. , 1997, Hepato-gastroenterology.

[7]  C. Chu,et al.  Severe clinical rebound upon withdrawal of corticosteroid before interferon therapy: Incidence and risk factors , 1996, Journal of gastroenterology and hepatology.

[8]  P. Marcellin,et al.  Treatment of chronic viral hepatitis. , 1994, Bailliere's clinical gastroenterology.

[9]  M. Greene,et al.  Fulminant Hepatic Failure in Non-Hodgkin Lymphoma Patients Treated with Chemotherapy , 1992 .

[10]  C. Kannan.  The Adrenal Gland , 1988, Clinical Surveys in Endocrinology.

[11]  C. Chu,et al.  HLA Class i antigen display on hepatocyte membrane in chronic hepatitis B virus infection: Its role in the pathogenesis of chronic type B hepatitis , 2005 .

[12]  R. Burk,et al.  Hepatitis B virus DNA contains a glucocorticoid-responsive element. , 1986, Proceedings of the National Academy of Sciences of the United States of America.

[13]  B. Graham,et al.  Opportunistic infections in endogenous Cushing's syndrome. , 1984, Annals of internal medicine.

[14]  J. Hoofnagle,et al.  Reactivation of chronic hepatitis B virus infection by cancer chemotherapy. , 1982, Annals of internal medicine.

[15]  A. Zuckerman,et al.  FULMINANT HEPATIC FAILURE IN LEUKAEMIA AND CHORIOCARCINOMA RELATED TO WITHDRAWAL OF CYTOTOXIC DRUG THERAPY , 1975, The Lancet.