HBsAg has been found in 7.5 to 20% of the cases with leukemia. Though asymptomatic increases in serum transaminase levels are common, overt hepatitis has been regarded rather rare. Among three patients with ALL treated in our hospital, two cases of fulminant hepatitis resulted in death and one case recovered from acute hepatitis.
In case I, 13-year-old boy, fulminant hepatitis developed after the completion of remission induction therapy with vincristin and prednisolone and intrathecal injection of methotrexate as CNS prophylaxis. In case 2, 13-year-old boy, fulminant hepatitis occurred after two courses of DCMP therapy for the remission induction. In case 3, 10-year-old girl, acute hepatitis with ascites occurred 2 months later from the day of complete hematological remission.
In these three cases, hepatitis B was evident when the patients were lymphopenic. Explanation by the development of hepatitis B by the immunological hypothesis, which has been previously presented, could not be applied to the aboved-mentioned cases.
