A 57-year-old woman presented with a purpuric rash. Cryoglobulins were detected, and a skin biopsy showed leukocytoclastic vasculitis. The alanine aminotransferase level was 119 IU/L, and the platelet count 63,000/mm3. The hepatitis B virus (HBV) DNA was 6.4 log10 copies/mL and became negative by week 6 of entecavir therapy. The antiphosphatidylserine-prothrombin complex antibody (anti-PS/PT) was 390-510 U/mL, and decreased to 69 U/mL at week 24, after cryoglobulin had become negative and the rash resolved. Among 20 HBV-infected patients without extrahepatic manifestations, low titers of anti-PS/PT were detected in 8 (40%). Clinical characteristics were similar in patients with or without anti-PS/PT. Low titers of anti-PS/PT in chronic hepatitis B have little clinical significance, whereas high titers may promote cryoprecipitate formation.
Since the national program of immunoprophylaxis against perinatal transmission of hepatitis B virus (HBV) was started in 1986, the HBV carrier rate in children was dramatically decreased. However, the cases of failure of the prevention still exist. In this study, we retrospectively analyzed the reasons of 56 cases of the failure of the prevention after the initiation of national program. Seventeen (31%) were not received the immunoprophylaxis of the national program by mistake. Seven (12%) were received the inappropriate doses of schedule. Our national program is relatively complicated compared to the method adopted by almost all other countries. Because of the universal vaccination program is easy to finish the schedule, we should consider converting our prevention schedule to the universal vaccination program.