Case Report
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World J Hepatol. Feb 27, 2011; 3(2): 56-60
Published online Feb 27, 2011. doi: 10.4254/wjh.v3.i2.56
A mutation of the start codon in the X region of hepatitis B virus DNA in a patient with non-B, non-C chronic hepatitis
Kiyotaka Fujise, Keiko Tatsuzawa, Midori Kono, Sadayori Hoshina, Akihito Tsubota, Minoru Niiya, Yoshihisa Namiki, Norio Tada, Hisao Tajiri
Kiyotaka Fujise, Keiko Tatsuzawa, Akihito Tsubota, Minoru Niiya, Hisao Tajiri, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kashiwa Hospital, The Jikei University School of Medicine, Chiba 277-8567, Japan
Kiyotaka Fujise, Keiko Tatsuzawa, Sadayori Hoshina, Akihito Tsubota, Yoshihisa Namiki, Norio Tada, Institute of Clinical Medicine and Research, The Jikei University School of Medicine, Chiba 277-8567, Japan
Midori Kono, Sadayori Hoshina, Department of Laboratory Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan
Author contributions: Fujise K, Tatsuzawa K, Hoshina S, Tsubota A performed the research; Fujise K, Tatsuzawa K, Kono M, Hoshina S, Tsubota A, Namiki Y, Tada N analyzed the research data; Fujise K, Tsubota A, Niiya M analyzed the clinical data; and Fujise K, Kono M, Hoshina S, Tsubota A, Tajiri H wrote the paper.
Correspondence to: Kiyotaka Fujise, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kashiwa Hospital, The Jikei University School of Medicine, 163-1 Kashiwa-shita, Kashiwa, Chiba 277-8567, Japan. kfujise@jcom.home. ne.jp
Telephone: +81-4-71641111 Fax: +81-4-71643488
Received: July 30, 2010
Revised: November 14, 2010
Accepted: November 21, 2010
Published online: February 27, 2011
Abstract

There are cases of hepatitis involving occult hepatitis B virus (HBV) infection in which, even though the HB surface antigen (HBsAg) is negative, HBV-DNA is detected by a polymerase chain reaction (PCR). We conducted a sequence analysis of the entire HBV region in a case of non-B non-C chronic hepatitis in a 46-year-old female. A diagnosis of non-B non-C chronic hepatitis was made. Although HBV markers, such as HBs antibody (anti-HBs), anti-HBc, HBeAg and anti-HBe, were negative, HBV-DNA was positive. Nested PCR was performed to amplify the precore region of HBV-DNA and all remaining regions by long nested PCR. Sequence analysis of the two obtained bands was conducted by direct sequencing. Compared with the control strains, the ATG (Methionine) start codon in the X region had mutated to GTG (Valine). It is assumed that a mutation at the start codon in the X region may be the reason why HBV markers are negative in some cases of hepatitis that involve occult HBV infection.

Keywords: Hepatitis B virus, X region, Mutation, Non-B non-C chronic hepatitis, Occult infection