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Dtsch Med Wochenschr. 2012 Jan;137(1-2):23-6. doi: 10.1055/s-0031-1292885. Epub 2011 Dec 16.

[Hepatitis-B reactivation during treatment with tumor necrosis factor-α blocker adalimumab in a patient with psoriasis arthritis].

[Article in German]

Author information

1
Klinik für Innere Medizin und Rheumatologie, Zeisigwaldkliniken Bethanien, Chemnitz. matthias_kouba@gmx.at

Abstract

HISTORY AND ADMISSION FINDINGS:

A 66-year-old man with acute fever, myalgia, arthralgia, restricted movement and neck stiffness was admitted to our emergency unit. Three weeks earlier treatment with adalimumab, a tumor necrosis factor(TNF)-alpha antagonist was started by the patient's dermatologist because of a psoriasis vulgaris with associated psoriasis arthritis. All previous laboratory tests where without pathological findings.

INVESTIGATIONS:

The imaging procedures showed no pathological findings. Transaminase and CRP levels were markedly elevated. Hepatitis serology revealed reactivation of a chronic hepatitis B infection, while a combined viral and toxic hepatitis was detected by liver biopsy.

TREATMENT AND COURSE:

On the day of admittance acute neurological symptoms developed including muscular cramps and dyskinesia. Hypotonia and tachyarrhythmia were treated with parenteral infusions and digitoxin. Reactivation of a chronic hepatitis B infection with subfulminant liver failure was diagnosed, caused by immunosuppressive therapy with adalimumab. The patient was transferred to be treated with the antiviral drug entecavir.

CONCLUSION:

The exclusion of acute and/or chronic hepatitis before using TNF-alpha antagonists is recommended but in daily routine often ignored. The presented case demonstrates the risk of reactivating a chronic hepatitis B during therapy with a TNF-alpha antagonist.

PMID:
22180279
DOI:
10.1055/s-0031-1292885
[Indexed for MEDLINE]
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