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• W3093914556 abstract "INTRODUCTION: Newer biologicals, immunosuppressive agents, monoclonal antibodies are constantly being approved for use in various conditions. Use of these agents maybe associated with reactivation of hepatitis B in susceptible individuals which can lead to increased morbidity and mortality. We report a case of hepatitis B reactivation leading to fatal fulminant hepatic failure following administration of belimumab. To the best of our knowledge, this is the first case report describing the untoward side effect of this drug. CASE DESCRIPTION/METHODS: A 53-year-old lady presented with nausea, vomiting, jaundice and obtundation. There was no prior history of cirrhosis. Patient had a history of overlap of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) and was taking hydroxychloroquine and prednisone. Given inadequate control, low dose methotrexate was added 4 months earlier and belimumab (Benlysta) was started 3 months before. Physical exam showed normal vitals in a morbidly obese somnolent woman with grade 3 encephalopathy. Serum chemistries showed total bilirubin of 23 mg/dl, alkaline phosphatase 173 IU/L, AST 136 U/L, ALT 178 U/L, INR 4.8, creatinine 1.2, sodium 141 mEq/L. MRI/MRCP/ultrasound liver doppler was normal. Hepatitis B surface antigen, hepatitis B core IgM and IgG were positive. HBV DNA viral load was 63 million IU/ml. Hepatitis Be antigen was negative. A diagnosis of pre-core mutant reactivation hepatitis B associated with biologic/immunosuppressant medication use resulting in fulminant hepatic failure was made. For hepatitis B reactivation, renally-dosed entecavir and tenofovir disoproxil were initiated. Given her morbid obesity, she was not considered a suitable candidate for liver transplantation. Patient's condition continued to decline and was transitioned to comfort measures. She died two days later. DISCUSSION: Hepatitis B reactivation is associated with significant morbidity and mortality such as HBV-associated hepatitis, acute liver failure and death or need for a liver transplant. Belimumab (Benlysta R) is a B-lymphocyte Stimulator (BLyS) inhibitor which was FDA approved for use in lupus in 2011. In addition to infusion/hypersensitivity/anaphylactic reactions, it has been associated with malignancy, progressive multifocal leukoencephalopathy, depression and serious infections. Reactivation of hepatitis B has not been reported so far. Fellows and residents should be cognizant of belimumab’s potential to reactivate hepatitis B resulting in acute liver failure and death." @default.
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• W3093914556 date "2020-10-01" @default.
• W3093914556 modified "2023-09-27" @default.
• W3093914556 title "S2663 Belimumab-Associated Reactivation of Pre-Core Hepatitis B Resulting in Fatal Fulminant Hepatic Failure" @default.
• W3093914556 doi "https://doi.org/10.14309/01.ajg.0000712700.95945.81" @default.
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