Thalidomide
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Thalidomide Hepatitis B reactivation: case report A 49-year-old woman developed hepatitis B virus (HBV) reactivation after treatment with thalidomide. The woman, who had amyloidosis, underwent an autograft in September 2005 using melphalan conditioning; before transplantation, she had negative hepatitis B surface antigen (HBsAg) and hepatitis B surface antibodies (HBsAb) and positive hepatitis B core antibodies (HBcAb), along with normal liver function tests. Lamivudine was started before conditioning and continued after transplantation. In January 2006, HBV DNA was not detectable; she had received aciclovir for herpes simplex virus prophylaxis until January 2006. Due to severe proteinuria and a persistent abnormal serum-free light chain κ : λ ratio in February 2006, she started receiving thalidomide 50 mg/day and dexamethasone every 2 weeks along with weekly cyclophosphamide. In May 2006, her thalidomide dose was increased to 100 mg/day and dexamethasone was discontinued. Cyclophosphamide was then stopped in July 2006 due to a good response and, in early January 2007, both thalidomide and lamivudine were discontinued. In early March 2007, she developed thoracic dermatomal varicella zoster virus (VZV) reactivation. The woman’s VZV reactivation responded to famciclovir treatment. In late March 2007, she developed an ALT level of 201 IU/L. Investigations in early April 2007 revealed the following levels: ALT 1306 IU/L, AST, 925 IU/L, alkaline phosphatase 297 IU/L and albumin 17 g/L; her INR was 2.2. Her HBV DNA levels were > 17 857 100 IU/mL. Serology revealed HBsAg+, HBcAb+ and HBeAg-. She started receiving entecavir and, by May 2007, her ALT levels had rapidly normalised. HBV DNA became undetectable in July 2007, but she remained HBsAg+. Author comment: "HBV reactivation in this patient was most probably related to thalidomide, although it is conceivable that concomitant lingering immunosuppressive effects of the autograft . . . and chemotherapy . . . contributed to some extent." Grigg AP, et al. Hepatitis B reactivation after thalidomide. Internal Medicine 801080622 Journal 38: 301-302, No. 4, Apr 2008 - Australia
0114-9954/10/1200-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 3 May 2008 No. 1200
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