FULMINANT-HEPATITIS FOLLOWING BONE-MARROW TRANSPLANTATION IN HEPATITIS-B VIRUS CARRIER SIBLINGS

A 19-year-old male healthy hepatitis B virus (HBV) carrier developed f ulminant hepatitis following allogenic bone marrow transplantation (BM T) from his brother, who was also a healthy HBV carrier, during the fi rst complete remission of acute myelogenic leukemia (M1, FAB classific ation). Serum markers related to both HBV and hepatitis C virus (HCV) were elevated during active liver injury when a point mutation in the precore (pre-C) region occurred in the HBV. The patient received low-d ose interferon alpha (IFN-alpha), while the dose of cyclosporin A was tapered; the patient eventually recovered from the liver injury. Fulmi nant hepatitis due to HBV and/or HCV following BMT is rare, and it is considered to have a very poor prognosis. The rationale for the use of low-dose IFN-alpha with cyclosporin A (CyA) is discussed.