Internal Medicine
Online ISSN : 1349-7235
Print ISSN : 0918-2918
CASE REPORTS
Successful Treatment with Adefovir of One Patient Whose Cryoglobulinemic Vasculitis Relapsed under Lamivudine Therapy and Who was Diagnosed to Have HBV Virologic Breakthrough with YMDD Mutations
Necati ÇakirÖmer Nuri PamukHasan ÜmitKenan Midilli
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Volume 45 (2006) Issue 21 Pages 1213-1215

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Abstract

We report a patient whose cryoglobulinemic vasculitis recurred due to reactivation of lamivudine-resistant HBV. Our patient with hepatitis B-related cryoglobulinemic vasculitis was administered lamivudine. Her vasculitis regressed, ALT normalized, HBV-DNA became negative. Under lamivudine therapy, her cryoglobulinemic cutaneous vasculitis recurred. ALT increased significantly; it was found that tyrosine-methionine-aspartate-aspartate (YMDD) motif in the DNA polymerase gene had been replaced by YIDD. Adefovir was added to lamivudine. During follow-up, her purpura disappeared, ALT normalized, HBV-DNA became negative. Our patient is the first whose cryoglobulinemic vasculitis recurred under lamivudine, who had a HBV virologic breakthrough with YMDD mutation, and was successfully treated with adefovir.

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© 2006 by The Japanese Society of Internal Medicine
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