ABSTRACT
We report the case of a male chronic hepatitis B virus (HBV) carrier with HLA-B27 spondyloarthrititis who developed fulminant hepatitis after discontinuation of methotrexate (MTX). Full recovery after therapy with lamivudine and adefovir allowed treatment with adalimumab which was well tolerated. Reactivation of hepatitis B after MTX withdrawal is a very rare complication, which can also occur in association with anti-TNF agents. In patients with positive serology for HBV prophylactic antiviral therapy is recommended.
Subject(s)
Antiviral Agents/therapeutic use , Hepatitis B virus/physiology , Hepatitis B/drug therapy , Immunosuppressive Agents/adverse effects , Methotrexate/adverse effects , Spondylitis, Ankylosing/drug therapy , Adalimumab , Adenine/analogs & derivatives , Adenine/therapeutic use , Adult , Anti-Inflammatory Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Drug Therapy, Combination , Hepatitis B/complications , Hepatitis B/virology , Humans , Immunosuppressive Agents/therapeutic use , Lamivudine/therapeutic use , Male , Methotrexate/therapeutic use , Organophosphonates/therapeutic use , Spondylitis, Ankylosing/complications , Virus ActivationABSTRACT
Comunicamos el caso de un varón portador crónico de virus de hepatitis B (VHB) con espondiloartritis B27 positivo que desarrolló una hepatitis fulminante tras la suspensión del tratamiento con metotrexato (MTX). Una total recuperación tras terapia con lamivudina y adefovir permitió un tratamiento con adalimumab sin otras complicaciones y buena tolerancia. La reactivación de hepatitis B tras suspensión de MTX es una complicación muy poco frecuente, que también puede ocurrir con los anti-TNF. En pacientes con serología positiva de VHB se recomienda tratamiento profiláctico con antivirales (AU)
We report the case of a male chronic hepatitis B virus (HBV) carrier with HLA-B27 spondyloarthrititis who developed fulminant hepatitis after discontinuation of methotrexate (MTX). Full recovery after therapy with lamivudine and adefovir allowed treatment with adalimumab which was well tolerated. Reactivation of hepatitis B after MTX withdrawal is a very rare complication, which can also occur in association with anti-TNF agents. In patients with positive serology for HBV prophylactic antiviral therapy is recommended (AU)
