Successful lamivudine therapy for post-chemotherapeutic fulminant hepatitis B in a hepatitis B virus carrier with non-Hodgkin's lymphoma: case reportand review of the literature

Reactivation of hepatitis B virus (HBV), especially after withdrawal of cor ticosteroids is a well-known complication during chemotherapy for lymphoma. The high mortality makes this complication one of the major obstacles to c ompleting the standard treatment for lymphoma in HBV carriers. We report a 58-year-old Japanese male HBV carrier who developed fulminant hepatitis aft er chemotherapy with cyclophosphamide and doxorubicin. Lamivudine was intro duced since his hepatitis was progressive under supportive treatment and sh owed an elevated level of HBV DNA. After initiation of lamivudine, HBV DNA decreased to be below the limit of detection within 3 weeks, and all chemic al tests for liver function recovered to the normal level within 4 weeks, e xcept for a slight elevation of total-bilirubin. There were no remarkable a dverse effects observed. To the best of our knowledge, six cases of post-ch emotherapeutic fulminant hepatitis including ours have been treated with la mivudine. A review of these cases indicated that lamivudine induced a promp t antiviral, biochemical, and clinical response. Lamivudine is highly recom mended for post-chemotherapeutic fulminant hepatitis caused by reactivation of HBV.