RESUMO
The wide use of lamivudine in chronic hepatitis B has produced a monotonic increase in patients with lamivudine resistance. Therefore, treating lamivudine resistance in chronic hepatitis B is a major concern in clinical practice for the treatment of hepatitis B virus (HBV). There is conflicting evidence on the outcome of pegylated interferon alpha (PEG-IFN alpha) therapy against lamivudine-resistant HBV, which is due to mutations in the YMDD motif. We experienced a patient with chronic hepatitis B who was successfully treated with PEG-IFN alpha-2a after the development of virologic and biochemical breakthrough during lamivudine therapy. Virologic breakthrough was associated with the emergence of YMDD mutants 48 months after starting lamivudine therapy. Treatment with PEG-IFN alpha-2a for 12 months resulted in an undetectable serum level of HBV DNA and the resolution of hepatitis, and the virologic response was maintained over 16 months after cessation of PEG-IFN alpha-2a.
Assuntos
Antivirais/uso terapêutico , Hepatite B Crônica/tratamento farmacológico , Interferon-alfa/uso terapêutico , Lamivudina/uso terapêutico , Polietilenoglicóis/uso terapêutico , Adulto , Alanina Transaminase/sangue , DNA Viral/análise , Farmacorresistência Viral , Hepatite B Crônica/diagnóstico , Humanos , Interferon alfa-2 , Fígado/patologia , Masculino , Proteínas RecombinantesRESUMO
Inflammatory pseudotumor is a benign disease, which is histologically composed of the inflammatory cells such as mature lymphocytes, plasma cells, and histiocytes. It usually occurs in the respiratory system, liver, central nervous system, and gastrointestinal tracts. However, inflammatory pseudotumor rarely occurs in the spleen. Pathologic diagnosis is essential for the definitive diagnosis because of the difficulty in distinguishing pseudotumor from lymphoproliferative disorders of the spleen. We report a case of inflammatory pseudotumor of the spleen. A 35-year-old woman complained of the intermittent epigastric pain for several months. Physical examination and laboratory findings were normal. Ultrasonography and abdominal computerized tomography showed a low attenuation splenic mass suggesting lymphoma. However, the pathologic findings of the resected spleen were consistent with those of the inflammatory pseudotumor. The spleen weighed 230 g containing a 6 x 5 x 5 cm-sized, well-circumscribed gray mass. The microscopic findings indicated the inflammatory cell infiltrations.
