Reactivation of hepatitis B in a patient with Crohn’s disease treated using infliximab
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
We encountered a case of reactivation of hepatitis B virus after administration of infliximab for Crohn’s disease. The use of infliximab was considered because the patient displayed abdominal symptoms and perianal lesions. Transaminases were normal, and hepatitis B virus (HBV) DNA was undetectable before treatment, so no antiviral treatment was used, and infliximab and low-dose 6-mercaptopurine were administered. This treatment was effective, but liver dysfunction and reactivation of HBV were observed after the fourth injection of infliximab. This is the first report of Crohn’s disease for which infliximab use was continued even after reactivation of HBV was observed. However, liver dysfunction was not improved by lamivudine. Antiviral treatment should be considered before administration of infliximab for patients with HBV.
- Candy S, Wright JP, Gerber M, Adams G, Gerig M, Goodman R. A double blind controlled study of azathioprine in the treatment and maintenance of remission in Crohn’s disease. Gut 1995;37:674–678. CrossRef
- Ewe K, Press A, Singe C, Stufler M, Ueberschaer B, Hommel G, et al. Azathioprine combined with prednisolone or monotherapy with prednisolone in active Crohn’s disease. Gastroenterology 1993;105:367–372.
- Present DH, Korelitz BI, Wisch N, Glass JL, Sachar DB, Pasternack BS. Treatment of Crohn’s disease with 6-mercaputopurine: a long-term, randomized, double blind study. N Engl J Med 1980;302:981–987.
- Pearson DC, May GR, Fick GH, Sutherland LR. Azathioprine and 6-mercaputopurine with Crohn’s disease. A meta-analysis. Ann Intern Med 1995;122:132–142.
- Targan SR, Hanauer SB, van Deventer SJ, Mayer L, Present DH, Braakman T, et al. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. Crohn’s Disease cA2 Study Group. N Engl J Med 1997;337:1029–1035. CrossRef
- Present DH, Rutgeerts P, Targan SR, Hanauer SB, Mayer L, van Deventer SJ, et al. Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 1999;340:1398–1405. CrossRef
- Sands BE, Anderson FH, Bernstein CN, Chey WY, Feagan BG, Fedorak RN, et al. Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med 2004;350:876–885. CrossRef
- Rutgeerts P, Sandborn WJ, Feagan BG, Reinisch W, Olson A, Johanns J, et al. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med 2005;353:2462–2476. CrossRef
- Michel M, Duvoux C, Hezode C, Cherqui D. Fulminant hepatitis after infliximab in a patients with hepatitis B virus treated for an adult onset Still’s disease. J Rheumatol 2003;30:1624–1625.
- Ostuni P, Botsios C, Punzi L, Sfriso P, Todesco S. Hepatitis B reactivation in a chronic hepatitis B surface antigen carrier with rheumatoid arthritis treated with infliximab and low dose methotrexate. Ann Rheum Dis 2003;62:686–687. CrossRef
- Ueno Y, Tanaka S, Shimamoto M, Miyanaka Y, Hiyama T, Ito M, et al. Infliximab therapy for Crohn’s disease in a patient with chronic hepatitis B. Dig Dis Sci 2005;50:163–166. CrossRef
- Wendling D, Auge B, Betting D, Lohse A, Huede GL, Bresson-Hadni S, et al. Reactivation of a latent precore mutant hepatitis B virus related chronic hepatitis during infliximab treatment for severe spondyloarthropathy. Ann Rheum Dis 2005;64:788–789. CrossRef
- Millonig G, Kern M, Ludwiczec O, Vogel W. Subfulminant hepatitis B after infliximab in Crohn’s disease: need for HBV-screening. World J Gastroenterol 2006;12:974–976.
- Madonia S, Orlando A, Scimeca D, Olivio M, Rossi F, Cottone M. Occult hepatitis B and infliximab-induced HBV reactivation. Inflamm Bowel Dis 2007;4:508–509. CrossRef
- Esteve M, Saro C, Gonzalez-Huix F, Suarex F, Forne M, Viver JM. Chronic hepatitis B reactivation following infliximab therapy in Crohn’s disease. Gut 2004;53:1363–1365. CrossRef
- del Valle Garcia-Sanchez M, Iglesias-Flores EM, de Dios-Vega JF, Gomes-Camacho F. Poyato-Ganzalez, Sancho-Zapatero R. Inflamm Bowel Dis 2004;10:701–702. CrossRef
- Oniankitan O, Duvoux C, Challine D, Mallat A, Chevalier X, Pawlotsky J, et al. Infliximab therapy for rheumatic disease in patients with chronic hepatitis B or C. J Reumatol 2004;31:107–109.
- Van Assche GA, Paintaud G, D’Haens G. Continuation of immunomodulators is not required to maintain adequate infliximab efficacy in patients with Crohn’s disease but may improve pharmacokinetics. Gastroenterology 2006;130Suppl 2:A923.
- Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology 2007;45:507–539. CrossRef
- Yeo W, Johnson PJ. Diagnosis, prevention and management of hepatitis B virus reactivation during anticancer therapy. Hepatology 2006;43:209–220. CrossRef
- Nathan DM, Angus PW, Gibson PR. Hepatitis B and C virus infections and anti-tumor necrosis factor-a therapy: guidelines for clinical approach. J Gastroenterol Hepatol 2006;21:1366–1371. CrossRef
- Reactivation of hepatitis B in a patient with Crohn’s disease treated using infliximab
Journal of Gastroenterology
Volume 43, Issue 5 , pp 397-401
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- Crohn’s disease
- Industry Sectors
- Author Affiliations
- 1. Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan