SUCCESSFUL TREATMENT WITH LAMIVUDINE FOR FULMINANT REACTIVATED HEPATITIS-B INFECTION FOLLOWING INTENSIVE THERAPY FOR HIGH-GRADE NON-HODGKINS-LYMPHOMA

Chronic carriers of Hepatitis B virus (HBV) infection, who are treated for malignant lymphoma, are at high risk of mortality from reactivate d HBV infection. We report a case of a 29-year-old male chronic HBV ca rrier who developed fulminant reactivated HBV infection following inte nsive chemotherapy for stage IVB large cell B-cell non-Hodgkin's lymph oma associated with extensive central nervous system and bone marrow i nvolvement. Prior to chemotherapy the patient had normal liver functio n tests and was negative for HBV DNA by semiquantitative PCR assay. Fu lminant HBV reactivation was confirmed following clinical deterioratio n, massive rises in hepatic transaminases (peak alanine aminotransfera se = 2,850 U/l), liver biopsy and rising levels of serum HBV DNA. Foll owing treatment with lamivudine 150 mg bd for 18 weeks dramatic and su stained recovery ensued. Symptoms and liver function tests improved wi thin days and HBV DNA became negative within 12 weeks. Our patient lat er died from relapsed lymphoma but without evidence of reactivated HBV infection. We advise that lamivudine should be considered during inte nsive chemotherapy treatment of chronic carriers of HBV.