| Hepatic Failure Caused by Reactivation of YMDD Mutants Occurring during Preemptive Lamivudine Therapy. | |
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MedLine Citation:
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PMID: 20559533 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Reactivation of hepatitis B virus (HBV) replication is a frequent phenomenon in patients receiving immunosuppressants or chemotherapy. It was recently reported that regional therapy, such as transarterial chemotherapy (TAC) or radiotherapy, can also induce HBV reactivation in patients with hepatocellular carcinoma (HCC), and this can be prevented by preemptive lamivudine treatment. We report an unusual case of fatal hepatitis caused by reactivation of the tyrosine-methionine-aspartate-aspartate (YMDD) lamivudine-resistant strain in a 51-year-old male patient with HCC who was receiving preemptive lamivudine therapy. This patient received combined helical tomotherapy and TAC for the treatment of HCC with pulmonary metastasis. HBV reactivation and hepatitis exacerbation occurred after 2 months of therapy, but preemptive antiviral therapy was continued. Laboratory tests showed that the serum HBV DNA level had increased by more than 10,000-fold and a severe elevation of the aminotransferase level to 1,060 U/L. Although adefovir was added to lamivudine immediately after detecting the YMDD mutants, the patient eventually died of hepatic failure. Our experience suggests that for preemptive therapy, the use of potent antiviral drugs with a low risk of drug resistance as well as close viral monitoring are important for chronic HBV carriers undergoing intensive anticancer therapy. |
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Authors:
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Chan Ran You; Jeong Won Jang; Jae Ki Choi; Si Hyun Bae; Seung Kew Yoon; Chul Seung Kay; Jong Young Choi |
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Publication Detail:
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Type: Journal Article Date: 2010-06-16 |
Journal Detail:
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Title: Gut and liver Volume: 4 ISSN: 1976-2283 ISO Abbreviation: Gut Liver Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-06-18 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101316452 Medline TA: Gut Liver Country: Korea (South) |
Other Details:
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Languages: eng Pagination: 262-5 Citation Subset: - |
Affiliation:
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Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea. |
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