Acute exacerbation in chronic hepatitis B virus infection

Santos, Marcio Vieira; Duarte, Maria Irma Seixas; Barone, Antonio Alci

doi:10.1590/S0037-86821996000300009

Abstracts

A case of an acute exacerbation of liver injury in a chronic HBV infected young male is reported. The correlation between the severe symptomatic hepatitis is done with the histopathologic findings of extense areas of bridging necrosis on the Iwer biopsy. The serological pattern for markers of HBV (HBsAg +, anti HBs g -, HBeAg -, anti HBe +, anti HBcIgG + and IgM -) confirm a chronic infection, ana the authors propose that the episode of severe hepatitis relates to the recent spontaneous seroconvertion of HBe Ag to anti HBe. Other causes of hepatitis were excluded, and the control liver biopsy (6 months later) showed normalization of hepatic architecture and absence of markers of viral replication in tissue and serum. A review of literature is done in an attempt to elucidate the diagnostic possibilities in this case, with emphasis on new immunoassays useful in differentiating between acute hepatitis B and acute exacerbation of a chronic hepatitis by the same virus.

acute exacerbation; HBe Ag- anti HBe seroconversion; Chronic HBV infection

Descreve-se um caso de exacerbação aguda sintomática em um paciente cronicamente infectado pelo VHB, mostrando-se correlação entre o quadro clínico grave (com insuficiência hepática transitória) e os achados histopatológicos de hepatite severa com extensas áreas de necrose em ponte. O perfil sorológico para marcadores do VHB (Ag HB S +, anti HB S Ag HBe -, anti HBe +, anti HB C IgG + IgM -) confirmou infecção crônica, e os autores levantam a hipótese de que a hepatite tenha se coiTelacionado â recente soroconversão Ag HBe para anti-HBe. Outras etiologias possíveis foram descartadas e se contou com biópsia controle 6 meses depois, mostrando normalização da arquitetura hepática e ausência de marcadores de replicação viral no tecido e no soro. Revisa-se a literatura sobre o diagnóstico diferencial cabível nesta situação, dando ênfase a novos ensaios sorológicos úteis na diferenciação entre infecção aguda pelo VHB e exacerbação aguda de uma hepatite crônica pelo mesmo agente.

Exacerbação aguda; Soroconversão AgHBe-anti Hb e; Infecção crônica pelo VHB

RELATO DE CASO

Acute exacerbation in chronic hepatitis B virus infection

Marcio Vieira Santos; Maria Irma Seixas Duarte; Antonio Alci Barone

^{Adress to correspondence} Adress to correspondence: Dr. Márcio Vieira Santos. Departamento de Moléstias Infecciosas e Parasitárias. HC/FMUSP. R. Dr. Enéias de Carvalho Aguiar 255, Cerqueira César, 05403-900 São Paulo, SP, Brasil.

ABSTRACT

A case of an acute exacerbation of liver injury in a chronic HBV infected young male is reported. The correlation between the severe symptomatic hepatitis is done with the histopathologic findings of extense areas of bridging necrosis on the Iwer biopsy. The serological pattern for markers of HBV (HB_sAg +, anti HB_sg -, HB_eAg -, anti HB_e +, anti HB_cIgG + and IgM -) confirm a chronic infection, ana the authors propose that the episode of severe hepatitis relates to the recent spontaneous seroconvertion of HB_e Ag to anti HB_e. Other causes of hepatitis were excluded, and the control liver biopsy (6 months later) showed normalization of hepatic architecture and absence of markers of viral replication in tissue and serum. A review of literature is done in an attempt to elucidate the diagnostic possibilities in this case, with emphasis on new immunoassays useful in differentiating between acute hepatitis B and acute exacerbation of a chronic hepatitis by the same virus.

Keywords: acute exacerbation. HB_e Ag- anti HB_e seroconversion. Chronic HBV infection.

RESUMO

Descreve-se um caso de exacerbação aguda sintomática em um paciente cronicamente infectado pelo VHB, mostrando-se correlação entre o quadro clínico grave (com insuficiência hepática transitória) e os achados histopatológicos de hepatite severa com extensas áreas de necrose em ponte. O perfil sorológico para marcadores do VHB (Ag HB_S +, anti HB_S Ag HB_e -, anti HB_e +, anti HB_C IgG + IgM -) confirmou infecção crônica, e os autores levantam a hipótese de que a hepatite tenha se coiTelacionado â recente soroconversão Ag HB_e para anti-HBe. Outras etiologias possíveis foram descartadas e se contou com biópsia controle 6 meses depois, mostrando normalização da arquitetura hepática e ausência de marcadores de replicação viral no tecido e no soro. Revisa-se a literatura sobre o diagnóstico diferencial cabível nesta situação, dando ênfase a novos ensaios sorológicos úteis na diferenciação entre infecção aguda pelo VHB e exacerbação aguda de uma hepatite crônica pelo mesmo agente.

Palavras-chave: Exacerbação aguda. Soroconversão AgHB_e-anti Hb_e. Infecção crônica pelo VHB.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Recebido para publicação em 10/02/95.

Laboratório de Investigação Médica em Hepatologia e de Patologia em Doenças Infecciosas, Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP.

1. Bortolotti F, Crivellaro C, Brunetto MR, Cadrobbi P, Bertolini A, Alberti A. Selection of a precore mutant of hepatitis B virus and reativation of chronic hepatitis B acquired in childhood. The Journal of Pediatrics 123:583-585,1993.
2. Brunetto MR, Stemler M, Shodel F, Will H, Ottobrelli M, Rizzetto M, Verme G, Bonino F. Identification of HBV variants which cannot produce precore derived HB_e Ag and may be responsible for severe hepatitis. Italian Journal of Gastroenterology 21:151-154,1989.
3. Carman WF, Jacyna MR, Hadziyannis S, Karayiannis P, McGarvey MJ, Markis A,Thomas HC. Mutation preventing formation of hepatitis B_e antigen in patients with chronic hepatitis B infection. Lancet 2:588-590,1989.
4. Chang MH, Sung JL, Lee CY, Chen CJ, Chen JS, Hsu HY, Lee PI, Chen DS. Factors affecting clearance of Hepatitis B_e antigen in hepatitis B surface antigen carrier children.The Journal of Pediatrics 115:385-390,1989.
5. Decker, RH. Diagnosis of hepatitis B virus. In: Viral hepatitis. Scientific basis and clinical managements. Churchill Livingstone, p 165-184, 1993.
6. Maruyama T, Lino S, Koike K, Yassuda K, Milich DR. Serology of acute exacerbation in chronic hepatitis B virus infection. Gastroenterology 105:1141-1151,1993.
7. Maruyama T, Schodel F, lino S, Koike K,Yasuda K, Peterson D, Milich DR. Distinguishing between acute and symptomatic chronic Hepatitis B virus infection. Gastroenterology 106:1006-1015,1994.
8. Noguchi A, Heyashi J, Nakashima K, Hirata M, Ikematsu H, Kashiwagi S. HBs Ag subtypes among HBs Ag carriers in Okinawa, Japan. Evidence of an important relationship in seroconversion from HB_e Ag to anti-HBe. Journal of Infection 28:141-150,1994.
9. Tsai SL, Chen PJ, Lai My, Yang PM, Sung JL, Huang JH, Hwang LH, Chang TH, Chen DS. Acute exacerbations of chronic type B hepatitis are accompanied by increased T cell responses to hepatitis B core and e antigens. Implications for hepatitis B_e antigen seroconversion. Journal of Clinical Investigation 89:87-96,1992.

Adress to correspondence:

Dr. Márcio Vieira Santos.

Departamento de Moléstias Infecciosas e Parasitárias.

HC/FMUSP.

R. Dr. Enéias de Carvalho Aguiar 255, Cerqueira César, 05403-900

São Paulo, SP, Brasil.

Publication Dates

Publication in this collection
08 Apr 2013
Date of issue
June 1996

History

Accepted
10 Feb 1995
Received
10 Feb 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Bortolotti F, Crivellaro C, Brunetto MR, Cadrobbi P, Bertolini A, Alberti A. Selection of a precore mutant of hepatitis B virus and reativation of chronic hepatitis B acquired in childhood. The Journal of Pediatrics 123:583-585,1993.

[2] 2. Brunetto MR, Stemler M, Shodel F, Will H, Ottobrelli M, Rizzetto M, Verme G, Bonino F. Identification of HBV variants which cannot produce precore derived HB_e Ag and may be responsible for severe hepatitis. Italian Journal of Gastroenterology 21:151-154,1989.

[3] 3. Carman WF, Jacyna MR, Hadziyannis S, Karayiannis P, McGarvey MJ, Markis A,Thomas HC. Mutation preventing formation of hepatitis B_e antigen in patients with chronic hepatitis B infection. Lancet 2:588-590,1989.

[4] 4. Chang MH, Sung JL, Lee CY, Chen CJ, Chen JS, Hsu HY, Lee PI, Chen DS. Factors affecting clearance of Hepatitis B_e antigen in hepatitis B surface antigen carrier children.The Journal of Pediatrics 115:385-390,1989.

[5] 5. Decker, RH. Diagnosis of hepatitis B virus. In: Viral hepatitis. Scientific basis and clinical managements. Churchill Livingstone, p 165-184, 1993.

[6] 6. Maruyama T, Lino S, Koike K, Yassuda K, Milich DR. Serology of acute exacerbation in chronic hepatitis B virus infection. Gastroenterology 105:1141-1151,1993.

[7] 7. Maruyama T, Schodel F, lino S, Koike K,Yasuda K, Peterson D, Milich DR. Distinguishing between acute and symptomatic chronic Hepatitis B virus infection. Gastroenterology 106:1006-1015,1994.

[8] 8. Noguchi A, Heyashi J, Nakashima K, Hirata M, Ikematsu H, Kashiwagi S. HBs Ag subtypes among HBs Ag carriers in Okinawa, Japan. Evidence of an important relationship in seroconversion from HB_e Ag to anti-HBe. Journal of Infection 28:141-150,1994.

[9] 9. Tsai SL, Chen PJ, Lai My, Yang PM, Sung JL, Huang JH, Hwang LH, Chang TH, Chen DS. Acute exacerbations of chronic type B hepatitis are accompanied by increased T cell responses to hepatitis B core and e antigens. Implications for hepatitis B_e antigen seroconversion. Journal of Clinical Investigation 89:87-96,1992.