https://doi.org/10.4081/reumatismo.2013.727

A false occult hepatitis B virus infection developed in a patient with psoriatic arthritis under infliximab and methotrexate therapy

Vol. 65 No. 6 (2013)
Submitted: 4 December 2013
Accepted: 28 January 2014
Published: 17 March 2014
false occult hepatitis B infection, anti-TNF-α, rheumatic diseases, HBV-DNA by real-time PCR.
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Authors

A. Notarnicola
notarnicola.antonella@gmail.com
Department of Medicine, Medical School, University of Bari, Italy.
F. Iannone
Department of Medicine, Medical School, University of Bari, Italy.
G. Lopalco
Department of Medicine, Medical School, University of Bari, Italy.
M. Covelli
Rheumatology Unit, Medical School, University of Bari, Italy.
G. Lapadula
Department of Medicine, Medical School, University of Bari, Italy.
Despite lacking of international guidelines about the management of patients with occult hepatitis B virus infection (OBI) starting TNF-α blockers, there is some evidence from real life settings that these drugs are safe in OBI patients with rheumatic diseases. On the contrary, the management of the so-called false OBI patients appears still undefined. We describe a case of acute hepatitis B virus (HBV) infection occurred in an anti-HBs and anti- HBc positive patient affected by psoriatic arthritis, who had been treated for five years with infliximab. Baseline HBV-DNA analysis had not been performed. Although HBs Ag was still negative and the transaminases in the normal range, HBV-DNA serum analysis surprisingly showed high replication rate. Entecavir was added, and three months later HBV-DNA was no longer detectable. Even if HBs Ag is persistently negative, the assessment of HBV-DNA should be recommended at least at baseline in order to rule out hidden active necro-inflammatory liver disease.

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How to Cite

Notarnicola, A., Iannone, F., Lopalco, G., Covelli, M., & Lapadula, G. (2014). A false occult hepatitis B virus infection developed in a patient with psoriatic arthritis under infliximab and methotrexate therapy. Reumatismo, 65(6), 298–301. https://doi.org/10.4081/reumatismo.2013.727

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