Importance of adequate immunosuppressive therapy for the recovery of patients with “life-threatening” severe exacerbation of chronic hepatitis B

Figure 1 Prothrombin time activities (A), alanine transaminase levels (B), total bilirubin levels (C), and HBV DNA polymerase activities (D) before and after the administration of corticosteroids in 11 “early high-dose” and 11 “non-early high-dose” patients. Thick and thin lines denote those of “early high-dose” and “non-early high-dose”, respectively. A: The mean activity at each point was 41±13, 77±23 and 81±19% in “early high-dose” and 29±13, 37±22 and 32±32% in “non-early high-dose”, respectively. ¹Statistically significant (P = 0.006); B: The mean level at each point was 976±990, 225±200 and 100±53 IU/L in “early high-dose” and 816±1072, 191±292 and 97±67 IU/L in “non-early high-dose”, respectively. ²Statistically significant (P<0.001); C: The mean activity at each point was 6.7±4.3, 3.8±4.4 and 1.5±0.7 mg/dL in “early high-dose” and 12.8±6.8, 14.2±8.3 and 22.2±14.9 mg/dL in “non-early high-dose”, respectively; D: The mean level at each point was 2325±3879 and 1282±3022 cpm in “early high-dose”, and 6866±16981 and 44±86 cpm in “non-early high-dose”, respectively.

Figure 2 Clinical courses of patient 7 (A), patient 4 (B), and patient 14 (C). A: Clinical course of a 68-year-old female patient (patient 7). She suffered from non-Hodgkin’s lymphoma and was found to be an HBV carrier with normal ALT, anti-HBe and no HBV DNA polymerase activity. After four cycles of chemotherapy (CHOP therapy), hematologic examination of her bone marrow showed complete remission, but reactivation of HBV occurred. High-dose corticosteroid was administered in combination with lamivudine because her serum HBV DNA titer was high. She gradually responded to the therapy. Thick solid, thin solid and dashed lines denote prothrombin time (PT), alanine transaminase (ALT) and total bilirubin (T-bili), respectively; B: Clinical course of a 27-year-old male patient (patient 4). He had natural reactivation of chronic hepatitis B and responded to corticosteroid therapy with transient HBeAg seroconversion; C: Clinical course of a 47-year-old male patient (patient 14). He suffered from chronic hepatitis B with anti-HBe and ulcerative colitis. He had HBV reactivation and convalesced spontaneously after the withdrawal of prednisolone. Six months later, he had repeated reactivation of HBV with marked prolonged PT and high level of viremia after the withdrawal of 6-mercaptopurine for ulcerative colitis, and was treated with corticosteroid and lamivudine, but did not respond to the combination therapy.