A Case of Acute Flare Leading to Hepatitis B Virus Reactivation Following Discontinuation of Nucleoside Analogues

Abstract

Background: Acute flares in chronic hepatitis B are mostly immunologic flares that often result from sudden withdrawal of the antiviral medications like Nucleoside Analogues. They can be life-threatening unless recognized and treated promptly, and there is increasing experience that preemptive antiviral treatment can diminish their occurrence and improve the clinical outcomes. The objective of this study is to report such a case, where sudden withdrawal of NAs led to Acute HBV Flare and HBV Reactivation in an Inactive HBV Carrier patient.

Case Presentation: This case report describes a 45 years old non diabetic normotensive woman presenting in the OPD of Brahmanbaria Medical College & Hospital 10 September 2022 with the complaints of yellow coloration of eyes and urine for 2 weeks and weakness, nausea, loss of appetite and low grade fever for the same duration. On examination, she was moderately icteric, had low grade fever, and there was mild tenderness in the right upper abdomen. On query, she stated that she was diagnosed as HBsAg positive four years back and after thorough evaluation, antivirals (NAs) were started. After continuing her medication regularly for the first three years, she stopped the drugs by herself, and came to us a few months later with her symptoms. She was diagnosed as a case of Acute HBV Flare leading to HBV Reactivation. Treatment was reinitiated, and she was counseled properly regarding not to stop medication by herself, and to be on regular follow up.

Conclusion: Acute HBV Flares and Hepatitis B Virus Reactivation are commonly found in patients who discontinue medication suddenly. Although most of the flares can be controlled effectively by prompt treatment, it is also not uncommon to find cases leading to hepatic failure, decompensation and death. So, all possible complications of treatment withdrawal patients should be monitored closely, and prompt treatment should be given.

Journal of Brahmanbaria Med. Coll. Volume 07 Issue 01 Jan 2025 ; 36-39