Reactivation of hepatitis B in a patient with spondyloarthritis after the suspension of methotrexate and efficacy of treatment with antivirals in association to adalimumab

Cobeta García, Juan Carlos; Medrano, Marta

doi:10.1016/S2173-5743(11)70041-7

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Abstract

We report the case of a male chronic hepatitis B virus (HBV) carrier with HLA-B27 spondyloarthrititis who developed fulminant hepatitis after discontinuation of methotrexate (MTX). Full recovery after therapy with lamivudine and adefovir allowed treatment with adalimumab which was well tolerated.

Reactivation of hepatitis B after MTX withdrawal is a very rare complication, which can also occur in association with anti-TNF agents. In patients with positive serology for HBV prophylactic antiviral therapy is recommended.

Keywords:

Hepatitis B virus

Spondyloarthritis

Methotrexate

Anti-TNF

Antivirals

Resumen

Comunicamos el caso de un varón portador crónico de virus de hepatitis B (VHB) con espondiloartritis B27 positivo que desarrolló una hepatitis fulminante tras la suspensión del tratamiento con metotrexato (MTX). Una total recuperación tras terapia con lamivudina y adefovir permitió un tratamiento con adalimumab sin otras complicaciones y buena tolerancia.

La reactivación de hepatitis B tras suspensión de MTX es una complicación muy poco frecuente, que también puede ocurrir con los anti-TNF. En pacientes con serología positiva de VHB se recomienda tratamiento profiláctico con antivirales.

Palabras clave:

Virus hepatitis B

Espondiloartritis

Metotrexato

Anti-TNF

Antivirales

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