Deutsche medizinische Wochenschrift (1946) · 2011
[Hepatitis-B reactivation during treatment with tumor necrosis factor-α blocker adalimumab in a patient with psoriasis arthritis].
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Kouba M, Rudolph S E, Hrdlicka P, Zuber M A
Аннотация
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.
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.