Two cases of viral reactivation from resolved hepatitis B in patients with rheumatoid arthritis who received biologic antirheumatic agents

Abstract

    We report two cases of viral reactivation from resolved hepatitis B in patients with rheumatoid arthritis who received biologic antirheumatic agents.Case1was a70-year-old male who had a history of blood transfusion but was negative for hepatitis B virus (HBV) surface antigen at first. During the use of methotrexate (MTX) and eternercept (ETN), he developed de novo hepatitis B. Lamivudine was administered immediately and his hepatitis was relieved soon.Case2was a51-year-old female whose HBV surface antibody was positive. During the use of MTX and ETN, her HBV-DNA signals turned positive (the level was below 2.1 log copies/ml) without liver dysfunction. Treatment with ETN was continued, and follow-up was performed without administering nucleotide analogs. The patient again showed an HBV-DNA-negative reaction. From a medical record investigation, the incidence of reactivation was calculated to be 6.3/1,000 person-years in our hospital.