Occult hepatitis B infection by a recombinant D/C virus in an immunosuppressed patient

• Main Authors: Gonçalo Pereira Cruz, Celene Sargento, Maria Conceição Ventura, Joaquim Oliveira, José Saraiva da Cunha
• Format: Article
• Language: English
• Published: Elsevier 2020-01-01
• Series: IDCases
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214250919303105

Approximately 300 million people worldwide were living with chronic hepatitis B virus infection as of 2016, however, this number does not account for those who might be living with occult hepatitis B virus infection due to difficulty diagnosing this condition. The multiple genotypes and the ability of the hepatitis B virus to acquire mutations that down-regulate its expression make occult hepatitis B virus infection a very elusive diagnosis. This is especially worrisome when there is a need to start immunosuppressive therapies, since there is a risk of reactivation in undiagnosed patients. We present a case of female patient who was referred to the consultation because she was about to start chemotherapy with an anti-CD20 agent and had a positive anti-HBc and anti-HBs. During routine workup an occult hepatitis B virus infection was diagnosed. Upon further study mutations in the PreCore and Basal Core Promoter regions were identified, as well as, a double genotype D/C. Therapy with tenofovir was initiated before the patient was started on chemotherapy. This case highlights the importance of comprehensive studying of patients who present with apparently resolved chronic hepatitis B virus infection, especially when they are about to start immunosuppressive therapies. Keywords: Hepatitis B, Recombinant genotype, Occult, Immunosuppressive therapy