Clinical Journal of Gastroenterology

, Volume 3, Issue 5, pp 254–258 | Cite as

A case of severe acute hepatitis C and delayed antibody production due to rituximab therapy

  • Masaaki Hiura
  • Ryo Onizuka
  • Ryoichi Narita
  • Shintaro Abe
  • Akinari Tabaru
  • Masaru Harada
Case Report

Abstract

A 59-year-old male patient underwent surgical treatment for non-Hodgkin’s lymphoma of the right scrotum in October 2007. He received a total of 4 courses of two different adjuvant chemotherapy regimens including rituximab from January to April 2008. In June 2008 he was hospitalized due to severe liver dysfunction with an alanine aminotransferase of 2039 IU/l and a prothrombin time of 23.3%. He was diagnosed with acute hepatitis C by the detection of hepatitis C virus (HCV) RNA and negative anti-HCV antibody, and his hepatic function improved with bed rest during hospitalization; however, the production of anti-HCV antibodies was not detected until January 2009. Severe liver dysfunction is uncommon among patients with acute hepatitis C, and the long window (8 months) between HCV infection and the development of anti-HCV antibodies observed in the present case may have been due, at least in part, to a B cell disorder caused by rituximab therapy. In addition to the well-known risk of reactivation of hepatitis B virus infection in patients undergoing chemotherapy, physicians should be aware of the potential effects of chemotherapy on the clinical course of HCV infection.

Keywords

Acute hepatitis Hepatitis C virus Humoral immunity Rituximab 

References

  1. 1.
    Maheshwari A, Ray S, Thuluvath PJ. Acute hepatitis C. Lancet. 2008;372:321–32.CrossRefPubMedGoogle Scholar
  2. 2.
    Schreiber GB, Busch MP, Kleinman SH, Korelitz JJ. The risk of transfusion-transmitted viral infections. N Engl J Med. 1996;334:1685–90.CrossRefPubMedGoogle Scholar
  3. 3.
    Ostenborg A, Dyer MJ, Bunjes D, Pangalis GA, Bastion Y, Catovsky D, et al. Phase II multicenter study of human CD52 antibody in previously treated chronic lymphocytic leukemia. European Study Group of CAMPATH-1H Treatment in Chronic Lymphocytic Leukemia. L Clin Oncol. 1997;15:1567–74.Google Scholar
  4. 4.
    Lazdina U, Alheim M, Nyström J, Hultgren C, Borisova G, Sominskaya I, et al. Priming of cytotoxic T cell responses to exogenous hepatitis B virus core antigen is B cell dependent. J Gen Virol. 2003;84:139–46.CrossRefPubMedGoogle Scholar
  5. 5.
    Crowley B, Woodcock B. Red cell aplasia due to parvovirus b19 in a patient treated with alemtuzumab. Br J Haematol. 2002;119:279–80.CrossRefPubMedGoogle Scholar
  6. 6.
    Suzan F, Ammor M, Ribrag V. Fatal reactivation of cytomegalovirus infection after use of rituximab for a post-transplantation lymphoproliferative disorder. N Engl J Med. 2001;345:1000.CrossRefPubMedGoogle Scholar
  7. 7.
    Sharma VR, Fleming DR, Slone SP. Pure red cell aplasia due to parvovirus B19 in a patient treated with rituximab. Blood. 2000;96:1184–6.PubMedGoogle Scholar
  8. 8.
    Coiffier B, Lepage E, Briere J, Herbrecht R, Tilly H, Bouabdallah R, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002;346:235–42.CrossRefPubMedGoogle Scholar
  9. 9.
    Yeo W, Chan PK, Ho WM, Zee B, Lam KC, Lei KI, et al. Lamivudine for the prevention of hepatitis B virus reactivation in hepatitis B s-antigen seropositive cancer patients undergoing cytotoxic chemotherapy. J Clin Oncol. 2004;22:927–34.CrossRefPubMedGoogle Scholar
  10. 10.
    Lok AS, Liang RH, Chiu EK, Wong KL, Chan TK, Todd D. Reactivation of hepatitis B virus replication in patients receiving cytotoxic therapy. Report of a prospective study. Gastroenterology. 1991;100:182–8.PubMedGoogle Scholar
  11. 11.
    Lau GK, Yiu HH, Fong DY, Cheng HC, Au WY, Lai LS, et al. Early is superior to deferred preemptive lamivudine therapy for hepatitis B patients undergoing chemotherapy. Gastroenterology. 2003;125:1742–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Hui CK, Cheung WW, Zhang HY, Au WY, Yueng YH, Leung AY, et al. Kinetics and risk of de novo hepatitis B infection in HBsAg-negative patients undergoing cytotoxic chemotherapy. Gastroenterology. 2006;131:59–68.CrossRefPubMedGoogle Scholar
  13. 13.
    Dizdar O, Tapan U, Aksoy S, Harputluoglu H, Kilickap S, Barista I. Liver dysfunction after chemotherapy in lymphoma patients infected with hepatitis C. Eur J Haematol. 2008;80:381–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Ennishi D, Terui Y, Yokoyama M, Mishima Y, Takahashi S, Takeuchi K, et al. Monitoring serum hepatitis C virus RNA in patients with HCV-infected CD20-positive B-cell lymphoma undergoing rituximab combination chemotherapy. Am J Hematol. 2008;83:59–62.CrossRefPubMedGoogle Scholar
  15. 15.
    Kami M, Hamaki T, Murashige N, Kishi Y, Kusumi E, Yuji K, et al. Safety of rituximab in lymphoma patients with hepatitis B or hepatitis C virus infection. Hematol J. 2003;4:159–62.CrossRefPubMedGoogle Scholar
  16. 16.
    Mizukoshi E, Rehermann B. Immune responses and immunity in hepatitis C virus infection. J Gastroenterol. 2001;36:799–808.CrossRefPubMedGoogle Scholar
  17. 17.
    Ishii S, Koziel MJ. Immune responses during acute and chronic infection with hepatitis C virus. Clin Immunol. 2008;128:133–47.CrossRefPubMedGoogle Scholar
  18. 18.
    Guidotti LG, Chisari FV. Immunobiology and pathogenesis of viral hepatitis. Annu Rev Pathol. 2006;1:23–61.CrossRefPubMedGoogle Scholar
  19. 19.
    Stamataki Z, Grove J, Balfe P, Mckeating JA. Hepatitis C virus entry and neutralization. Clin Liver Dis. 2008;12:693–712.CrossRefPubMedGoogle Scholar
  20. 20.
    Yeo W, Chan TC, Leung NW, Lam WY, Mo FK, Chu MT, et al. Hepatitis B virus reactivation in lymphoma patients with prior resolved hepatitis B undergoing anticancer therapy with or without rituximab. J Clin Oncol. 2009;27:605–11.CrossRefPubMedGoogle Scholar
  21. 21.
    Roe B, Hall WW. Cellular and molecular interactions in coinfection with hepatitis C virus and human immunodeficiency virus. Expert Rev Mol Med. 2008;10:30.CrossRefGoogle Scholar
  22. 22.
    Soriano V, Vispo E, Labarga P, Medrano J, Barreiro P. Viral hepatitis and HIV co-infection. Antiviral Res. 2010;85:303–15.CrossRefPubMedGoogle Scholar
  23. 23.
    McLaughlin P, Grillo-López AJ, Link BK, Levy R, Czuczman MS, Williams ME, et al. Rituximab chimeric anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma: half of patients respond to a four-dose treatment program. J Clin Oncol. 1998;16:2825–33.PubMedGoogle Scholar
  24. 24.
    Onrust SV, Lamb HM, Balfour JA. Rituximab. Drugs. 1999;58:79–88.CrossRefPubMedGoogle Scholar
  25. 25.
    Roccatello D, Baldovino S, Rossi D, Giachino O, Mansouri M, Naretto C, et al. Rituximab as a therapeutic tool in severe mixed cryoglobulonemia. Clin Rev Allerg Immunol. 2008;34:111–7.CrossRefGoogle Scholar
  26. 26.
    Besson C, Canioni D, Lepage E, Pol S, Morel P, Lederlin P, et al. Characteristics and outcome of diffuse large B-cell lymphoma in hepatitis C virus-positive patients in LNH 93 and LNH 98 Groupe d’Etude des Lymphomes de l’Adulte programs. J Clin Oncol. 2006;24:953–60.CrossRefPubMedGoogle Scholar
  27. 27.
    Gea-Banacloche JC. Rituximab-associated infections. Semin Hematol. 2010;47:187–98.CrossRefPubMedGoogle Scholar
  28. 28.
    Francisci D, Falcinelli F, Schiaroli E, Capponi M, Belfiori B, Flenghi L, et al. Management of hepatitis B virus reactivation in patients with hematological malignancies treated with chemotherapy. Infection. 2010;38:58–61.CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2010

Authors and Affiliations

  • Masaaki Hiura
    • 1
  • Ryo Onizuka
    • 1
  • Ryoichi Narita
    • 1
  • Shintaro Abe
    • 1
  • Akinari Tabaru
    • 1
  • Masaru Harada
    • 1
  1. 1.Third Department of Internal MedicineUniversity of Occupational and Environmental Health, Japan School of MedicineKitakyushuJapan

Personalised recommendations