Hepatitis B virus reactivation during combined therapy with deferiprone and desferioxamine in a hepatitis B surface antigen thalassemic carrier.

In this report we firstly describe a case of reactivation of hepatitis B virus (HBV) replication occurred in a patient affected by Thalassemia major which underwent a combined chelation therapy with desferioxamine (DFO) and deferiprone (DFP). Clinical symptom and increase in alanine aminotransferase (ALT) level were detected when the prescription of DFO (30 mg/kg) was increased from 3 to 5 days/week; a raise in HBV-DNA levels of greater than or equal to tenfold compared with baseline was thereafter detected. Diagnosis was troublesome because increasing ALT levels, first suggested toxicity to DFP administration. However, HBV reactivation in our patient cannot be definitively attributed to combined regimen administration: the patient was on regular transfusion therapy and either coincidental further infection or spontaneous reactivation of HBV could not be completely ruled out. Furthermore, a background of immunologic abnormalities had been previously reported in thalassemia and postulated to be secondary to iron overload or DFO therapy itself.