内容紹介
Chemotherapy-Induced Reactivation of Hepatitis B in Recurrent Breast Cancer―A Case Report
Summary
It is known that reactivation of hepatitis B virus(HBV)is an important complication of chemotherapy, and it can cause fatally severe hepatitis in some cases. A 72-year-old woman, underwent radical mastectomy for left breast cancer at the age of 35 years. In January 2008, local recurrence and multiple bone metastases occurred, and chemotherapy was started. S-1(80 mg/day for 28 consecutive days followed by a 14-day rest period)was used as the fourth-line of treatment, but grade 3 anemia(Hb 6.6 g/dL)developed at the end of seventh course. Therefore, blood transfusion was performed. Five months after transfusion, blood tests showed elevated liver function markers and HBs antigen positivity, so post-transfusion hepatitis was suspected. However, it was diagnosed as de novo hepatitis caused by reactivation of HBV from occult infection, as the patient's stored sample before the transfusion tested positive for HBV-DNA. The hepatitis did not become severe, but it was a persistent infection with continued administration of a nucleoside analog. Identifying the reactivation risk and taking appropriate action based on guidelines are necessary for administering chemotherapy safely to patients with occult HBV infection.
要旨
B型肝炎ウイルス(HBV)の再活性化は化学療法後の合併症として重要であり,致死的な重症肝炎を発症し得ることが知られている。症例は72歳,女性。35歳時に左乳癌に対し定型的乳房切除術を施行。2008年1月遠隔再発を認め,化学療法を開始した。fourth-lineとしてS-1を選択したが,7コース時にgrade 3の貧血を生じ,輸血療法が行われた。輸血後5か月で肝機能マーカーの上昇とHBs抗原陽性が判明し,輸血後肝炎が疑われた。しかし,輸血前の保管検体からもHBV-DNA陽性が判明したため,既往感染からの再活性化型肝炎(de novo B型肝炎)と診断された。HBV既往感染症例では化学療法を安全に行うために,再活性化リスクの認識とガイドラインに沿った適切な対応が必要である。
目次
Summary
It is known that reactivation of hepatitis B virus(HBV)is an important complication of chemotherapy, and it can cause fatally severe hepatitis in some cases. A 72-year-old woman, underwent radical mastectomy for left breast cancer at the age of 35 years. In January 2008, local recurrence and multiple bone metastases occurred, and chemotherapy was started. S-1(80 mg/day for 28 consecutive days followed by a 14-day rest period)was used as the fourth-line of treatment, but grade 3 anemia(Hb 6.6 g/dL)developed at the end of seventh course. Therefore, blood transfusion was performed. Five months after transfusion, blood tests showed elevated liver function markers and HBs antigen positivity, so post-transfusion hepatitis was suspected. However, it was diagnosed as de novo hepatitis caused by reactivation of HBV from occult infection, as the patient's stored sample before the transfusion tested positive for HBV-DNA. The hepatitis did not become severe, but it was a persistent infection with continued administration of a nucleoside analog. Identifying the reactivation risk and taking appropriate action based on guidelines are necessary for administering chemotherapy safely to patients with occult HBV infection.
要旨
B型肝炎ウイルス(HBV)の再活性化は化学療法後の合併症として重要であり,致死的な重症肝炎を発症し得ることが知られている。症例は72歳,女性。35歳時に左乳癌に対し定型的乳房切除術を施行。2008年1月遠隔再発を認め,化学療法を開始した。fourth-lineとしてS-1を選択したが,7コース時にgrade 3の貧血を生じ,輸血療法が行われた。輸血後5か月で肝機能マーカーの上昇とHBs抗原陽性が判明し,輸血後肝炎が疑われた。しかし,輸血前の保管検体からもHBV-DNA陽性が判明したため,既往感染からの再活性化型肝炎(de novo B型肝炎)と診断された。HBV既往感染症例では化学療法を安全に行うために,再活性化リスクの認識とガイドラインに沿った適切な対応が必要である。