Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2015; 21(7): 2214-2219
Published online Feb 21, 2015. doi: 10.3748/wjg.v21.i7.2214
Combined glucocorticoid and antiviral therapy of hepatitis B virus-related liver failure
Jan-Hendrik Bockmann, Maura Dandri, Stefan Lüth, Nadine Pannicke, Ansgar W Lohse
Jan-Hendrik Bockmann, Maura Dandri, Stefan Lüth, Nadine Pannicke, Ansgar W Lohse, 1st Deparment of Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Author contributions: Bockmann JH, Lüth S and Lohse AW performed and designed research; Bockmann JH, Dandri M, Lüth S, Pannicke N and Lohse AW analyzed data; Bockmann JH, Dandri M and Lohse AW wrote the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jan-Hendrik Bockmann, MD, 1st Deparment of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr.52, 20246 Hamburg, Germany. j.bockmann@uke.de
Telephone: +49-40-741053910 Fax: +49-40-741058531
Received: June 26, 2014
Peer-review started: June 26, 2014
First decision: July 9, 2014
Revised: August 15, 2014
Accepted: September 29, 2014
Article in press: September 30, 2014
Published online: February 21, 2015
Processing time: 230 Days and 11.8 Hours
Abstract

Acute hepatic failure due to hepatitis B virus (HBV) can occur both during primary infection as well as after reactivation of chronic infection. Guidelines recommend considering antiviral therapy in both situations, although evidence supporting this recommendation is weak. Since HBV is not directly cytopathic, the mechanism leading to fulminant hepatitis B is thought to be primarily immune-mediated. Therefore, immunosuppression combined with antiviral therapy might be a preferred therapeutic intervention in acute liver failure in hepatitis B. Here we report our favourable experience in three hepatitis B patients with fulminant hepatic failure who were treated by combining high-dose steroid therapy with standard antiviral treatment, which resulted in a rapid improvement of clinical and liver parameters.

Keywords: Acute liver failure; Hepatitis B virus; Prednisolone; Reactivation; Rituximab

Core tip: In the reported cases we describe our positive experience with combined glucocorticoid and nucleotide analogue therapy in two cases of severe reactivations of chronic hepatitis B virus (HBV) infection and in one case of acute fulminant HBV infection. Rapid improvement of liver parameters and virological response was obtained in all three cases. Thus, the reported data emphasize the need for the further assessment of this therapeutic strategy and for the development of systematic clinical trials.