Vol.22 No.3

Case Report

Reactivation of hepatitis B virus in a hepatitis B surface antigen-negative patient with rheumatoid arthritis treated with methotrexate

Authors

Keisuke Watanabe1 , Kaoru Takase1 , Shigeru Ohno1 , Haruko Ideguchi1 , Akito Nozaki2 , Yoshiaki Ishigatsubo3

  • Center for Rheumatic Diseases, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
  • Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
  • Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Received:

18 February 2011

Accepted:

16 August 2011

Published online:

8 September 2011

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Abstract

Immunosuppressive therapy can induce viral reactivation in patients with chronic hepatitis B virus (HBV) infection and, more rarely, in patients with resolved HBV infection. We report the case of a 57-year-old Japanese woman with rheumatoid arthritis (RA) who developed de-novo hepatitis B virus-related hepatitis after methotrexate (MTX) therapy. Entecavir and oral prednisolone following steroid pulse therapy were administered and her liver function recovered. MTX is widely used for RA for its efficiency and safety. But some cases of HBV reactivation caused by MTX, including de-novo hepatitis, have been reported. Considering these conditions, more attention should be paid when using MTX in patients with RA. And more studies are needed to determine who needs screening of HBV, monitoring of HBV-DNA, and prophylaxis with chemotherapy or immunosuppressive therapy.

Key words

Hepatitis B - Rheumatoid arthritis - Methotrexate