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Reactivação do vírus da hepatite B em doente com Doença de Crohn sob terapêutica com infliximab : caso clínico
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A reactivação do VHB tem sido descrita em doentes sob terapêutica imunossupressora ou quimioterapia. Uma doente do sexo feminino, 48 anos, com doença de Crohn e com história prévia de hepatite aguda por VHB, a realizar terapêutica imunossupressora com Azatioprina e Infliximab surge com um quadro de icterícia. Foram realizadas serologias que demonstraram “reverse seroconversion”, i.e., reaparecimento do AgHBs, com elevação das transaminases e carga viral do VHB de 122000000 UI/ml. Previamente à introdução do Infliximab, a doente fez o anti-TNF Adalimumab e enquanto fazia este fármaco assistiu-se ao desaparecimento do anticorpo anti-HBs e ao surgimento de carga viral detectável.
Este caso reflecte a importância da monitorização de doentes com história prévia de infecção pelo VHB a fazerem terapêutica com anti-TNF, em que o diagnóstico precoce de perda de imunidade para o VHB deve levar à adopção de medidas terapêuticas (anti-virais) que evitem episódios de hepatite aguda, que podem em alguns casos ser graves.
HBV reactivation has been described in patients under imunossupression or during chemotherapy. This is the case of a 48 year old female, with Crohn’s disease and history of acute hepatitis B. While taking Azathioprine and Infliximab she appeared with jaundice. She showed reverse seroconversion, with conversion to HBsAg-positive status, elevation of ALT and AST and an HBV DNA level of 122000000 IU/ml. Before starting therapy with Infliximab, the patient was already taking Adalimumab, another anti-TNF. While she was taking Adalimumab, she turned anti-HBs negative and her serum HBV DNA became detectable. This case reinforces the role of HBV screening in patients under anti-TNF therapies with previous history of HBV infection, since in such cases the early diagnosis of HBV reactivation should prompt therapeutic measures (antiviral therapy) to prevene episodes of acute hepatitis, that can have a poor outcome in some patients.
HBV reactivation has been described in patients under imunossupression or during chemotherapy. This is the case of a 48 year old female, with Crohn’s disease and history of acute hepatitis B. While taking Azathioprine and Infliximab she appeared with jaundice. She showed reverse seroconversion, with conversion to HBsAg-positive status, elevation of ALT and AST and an HBV DNA level of 122000000 IU/ml. Before starting therapy with Infliximab, the patient was already taking Adalimumab, another anti-TNF. While she was taking Adalimumab, she turned anti-HBs negative and her serum HBV DNA became detectable. This case reinforces the role of HBV screening in patients under anti-TNF therapies with previous history of HBV infection, since in such cases the early diagnosis of HBV reactivation should prompt therapeutic measures (antiviral therapy) to prevene episodes of acute hepatitis, that can have a poor outcome in some patients.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016
Palavras-chave
Hepatite B Doença de Crohn Reactivação Infliximab