Fatal Reactivation of Hepatitis B Virus in a Patient Who Was Hepatitis B Surface Antigen Negative and Core Antibody Positive Before Receiving Chemotherapy for Non-Hodgkin Lymphoma

Patients who are hepatitis B surface antigen (HBsAg) positive are at risk for hepatitis flare when receiving cytotoxic or immunosuppressive therapy. It has been reported that as high as 50% of HBsAg-positive individuals who undergo chemotherapy develop elevation of liver transaminases. According to current Association for the Study of Liver Diseases guidelines, prophylactic lamivudine should be routinely administered to HBsAg-positive patients with malignancy before chemotherapy. However, occult hepatitis B virus (HBV) infection, defined as HBsAg negative and HBV DNA positive, regardless of HBV core antibody (anti-HBc) status, is not infrequent in HBV endemic areas. Here, we report the case of a B-cell non-Hodgkin lymphoma female patient who was negative for HBsAg, but positive for anti-HBc at the time of chemotherapy. Unfortunately, she developed a fatal HBV reactivation after completing the course of chemotherapy. This case highlights the potential role of lamivudine or other nucleos(t)ide analogue prophylaxis in anti-HBc-positive malignant patient who is about to undergo chemotherapy to provide better coverage for occult HBV infection.