Reactivación del virus de la hepatitis B secundaria a tratamiento inmunosupresor / Hepatitis B virus reactivation secondary to immunosuppressive treatment

RESUMEN

Se presenta el caso de una mujer de 57 años con síntomas dispépticos, con ANAS +, manejada con terapia inmunosupresora y sospecha clínica de LES. Posteriormente presenta ascitis y elevación de las aminotransferasas. Se detecta HBsAg + con carga viral DNA-HBV elevada. Conclusión: Se deben tomar pruebas para hepatitis B antes de iniciar una terapia inmunosupresora. Los corticoesteroides y otros inmunosupresores pueden reactivar el virus de la hepatitis B y producir cuadros clínicos severos que ponen en riesgo la vida del paciente.

ABSTRACT

Reactivation of hepatitis B virus (HBV) replication in patients undergoing immunosuppressive therapy may precipitate flare ups of chronic HBV infections. We present the case of a 57 year old female who had suffered six weeks of abdominal discomfort, dyspepsia, and joint paint. After three weeks of therapy with prednisolone, methotrexate and chloroquine, the patient developed ascites and increased serum levels of AST and ALT. Chronic hepatitis B infection was confirmed by liver biopsy. Conclusion: Tests for hepatitis B should be conducted before immunosuppressive therapy is begun. Corticosteroids and other immune suppressors can reactivate hepatitis B and produce severe clinical symptoms and can put the patient's life at risk.