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Intern Med. 2006;45(11):721-4. Epub 2006 Jul 3.

Anti-HBs-positive liver failure due to hepatitis B virus reactivation induced by rituximab.

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Ehime University Graduate School of Medicine, Department of Gastroenterology and Metabology, Shitsukawa, Toon.


A 59-year-old man developed acute hepatitis with reactivated hepatitis B virus (HBV) following administration of rituximab (anti-CD20 monoclonal antibody). The patient was diagnosed with malignant lymphoma in 1998, and virus marker testing indicated HBV surface antigen (HBsAg)-negative and anti-HBs antibody (anti-HBs)-positive results when chemotherapy including rituximab was started. Levels of aminotransferases were elevated, and HBsAg results turned positive. Despite therapy for late-onset hepatic failure, the patient died. Rituximab appears likely to have induced HBV reactivation in this case. Anti-viral agents should be administered for both HBsAg-positive and anti-HBs-positive patients who are scheduled to receive rituximab.

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