K. Takase et al., LATE-ONSET HEPATIC-FAILURE DUE TO HEPATITIS-B VIRUS WITH MUTATIONS INTHE PRECORE REGION, Journal of gastroenterology, 30(5), 1995, pp. 672-676
A 60-year-old man complained of severe general fatigue on October 11,
1992. Pertinent laboratory findings were: aspantate aminotransferase (
AST) 1920 IU, alanine aminotransferase (ALT) 2050 IU, and total biliru
bin (T.Bil) 124 micromol/l (normal range, 0 - 17 micromol/l). Virologi
cal assay revealed that hepatitis B surface antigen (HBsAg), anti-hepa
titis B e (HBe), anti-HBc, and immunoglobulin M (IgM) anti-HBc were po
sitive, and anti-HBs, HBeAg, and anti-delta antibody were negative. A
diagnosis of acute hepatitis due to hepatitis B virus was made. Despit
e a decrease in transaminase, jaundice worsened and prothrombin time w
as prolonged. On the 60th day of hospitalization, massive ascites deve
loped, but the patient's consciousness was not impaired. Although albu
min and diuretics were given, the ascites further increased. Paracente
sis of 2000 ml of ascitic fluid was performed twice a week. On the 120
th day of hospitalization, the patient passed black stools and he exhi
bited renal failure 3 weeks later. Although severe jaundice persisted,
he was still alert. On the 150th day of hospitalization, massive gast
rointestinal bleeding occurred, due to hemorrhagic gastritis. Despite
receiving intensive care, the patient died. Determination of the HBV D
NA sequence revealed two point mutations in the pre-core region; these
have not been reported elsewhere.