ABSTRACT
Chronic carriers of Hepatitis B virus (HBV) infection, who are treated for malignant lymphoma, are at high risk of mortality from reactivated HBV infection. We report a case of a 29-year-old male chronic HBV carrier who developed fulminant reactivated HBV infection following intensive chemotherapy for stage IVB large cell B-cell non-Hodgkin's lymphoma associated with extensive central nervous system and bone marrow involvement. Prior to chemotherapy the patient had normal liver function tests and was negative for HBV DNA by semiquantitative PCR assay. Fulminant HBV reactivation was confirmed following clinical deterioration, massive rises in hepatic transaminases (peak alanine aminotransferase = 2,850 U/l), liver biopsy and rising levels of serum HBV DNA. Following treatment with lamivudine 150 mg bd for 18 weeks dramatic and sustained recovery ensued. Symptoms and liver function tests improved within days and HBV DNA became negative within 12 weeks. Our patient later died from relapsed lymphoma but without evidence of reactivated HBV infection. We advise that lamivudine should be considered during intensive chemotherapy treatment of chronic carriers of HBV.
Subject(s)
Anti-HIV Agents/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Carrier State , Hepatitis B/drug therapy , Lamivudine/administration & dosage , Lymphoma, B-Cell/drug therapy , Lymphoma, Non-Hodgkin/drug therapy , Adult , Fatal Outcome , Hepatitis B/etiology , Humans , Lymphoma, B-Cell/complications , Lymphoma, B-Cell/diagnosis , Lymphoma, Non-Hodgkin/complications , Lymphoma, Non-Hodgkin/diagnosis , Male , RecurrenceABSTRACT
OBJECTIVE: To present a case of severe pre-eclampsia in which diagnosis of the antiphospholipid syndrome was made after delivery, and to discuss pointers to the diagnosis. CLINICAL FEATURES: A 32-year-old woman in her second pregnancy presented at 32 weeks' gestation with severe pre-eclampsia. Her persisting severe postpartum illness was investigated. The presence of anticardiolipin antibodies and lupus anticoagulant led to the diagnosis of antiphospholipid syndrome. INTERVENTION AND OUTCOME: Induction of labour was successful, with delivery of a healthy baby girl. The patient made a full recovery after treatment with corticosteroids and warfarin. CONCLUSION: The antiphospholipid syndrome should be considered in cases of severe early pre-eclampsia.
