Case Report
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Feb 14, 2006; 12(6): 974-976
Published online Feb 14, 2006. doi: 10.3748/wjg.v12.i6.974
Subfulminant hepatitis B after infliximab in Crohn’s disease: Need for HBV-screening?
Gunda Millonig, Michaela Kern, Othmar Ludwiczek, Karin Nachbaur, Wolfgang Vogel
Gunda Millonig, Michaela Kern, Othmar Ludwiczek, Karin Nachbaur, Wolfgang Vogel, Department of Gastroenterology and Hepatology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
Supported by the “Verein zur Förderung der Wissenschaft in Gastroenterologie und Hepatologie”
Correspondence to: Gunda Millonig, MD, Department of Gastroenterology and Hepatology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria. gunda.millonig@uibk.ac.at
Telephone: +43-512-504-23401 Fax: +43-512-504-24052
Received: April 30, 2005
Revised: May 10, 2005
Accepted: June 9, 2005
Published online: February 14, 2006
Abstract

Infections are a major adverse effect during the treatment with anti-TNF-α. While exclusion of any bacterial infection and screening for tuberculosis are mandatory before initiating a therapy with anti-TNF- α-antibodies, there are no guidelines whether to screen for or how to deal with chronic viral infections such as hepatitis B. In this case report, we have described a patient with Crohn's disease who developed subfulminant hepatitis B after the fourth infusion of infliximab due to an unrecognized HBs-antigen carrier state. He recovered completely after lamivudine therapy was started, but this severe adverse event could have been prevented if screening for HBV and pre-emptive therapy with lamivudine would have been started prior to infliximab. We therefore strongly argue in favor of extended screening recommendations for infectious diseases including viral infections before considering a therapy with infliximab.

Keywords: Hepatitis B, TNF alpha, Lamivudine