Withdrawal of immunosuppressive therapy in allogeneic bone marrow transplantation reactivates chronic viral hepatitis C.

A 28-year-old female patient with acute myelogenous leukemia and post-transfusion chronic viral hepatitis C received an allogeneic bone marrow transplantation (BMT) in first complete remission. The inflammatory activity of chronic hepatitis C decreased dramatically with the start of BMT and during the whole course of cyclosporin A treatment. After the immunosuppressive therapy was stopped, however, the chronic hepatitis C activity increased and the serum alanine amino-transferase levels thereafter remained as high as before BMT. Hepatitis C virus RNA was detected by polymerase chain reaction in serum drawn 60 days and 52 months after BMT. Since fulminant viral hepatitis B may take place after tapering of immunosuppressive therapy following BMT due to an excessive response of recovering immunity to the actively replicating virus during immune suppression, careful monitoring of liver function for patients with chronic viral hepatitis C in BMT is suggested.