Hepatitis B surface antigen-negative but hepatitis B envelope antigen-positive false occult hepatitis B virus infection: A case report

doi:10.4254/wjh.v16.i10.1199

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World Journal of Hepatology

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Case Report

World J Hepatol. Oct 27, 2024; 16(10): 1199-1207
Published online Oct 27, 2024. doi: 10.4254/wjh.v16.i10.1199

Hepatitis B surface antigen-negative but hepatitis B envelope antigen-positive false occult hepatitis B virus infection: A case report

Xiao-Yu Yu, Guang-Bo Li, Zhi-Jun Li, Zhou-Xiang Zhang, Qian-Kun Xuan, Fei Fu, Shu-Sheng Yang

Shu-Sheng Yang, Qian-Kun Xuan, Zhi-Jun Li, Guang-Bo Li, Xiao-Yu Yu, Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China

Fei Fu, Zhou-Xiang Zhang, Department of Obstetrics and Gynecology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China

Co-first authors: Shu-Sheng Yang and Fei Fu.

Co-corresponding authors: Guang-Bo Li and Xiao-Yu Yu.

Author contributions: Yang SS, Li GB, and Yu XY contributed to conceptualization and methodology; Fu F contributed to data curation and writing the original draft; Xuan QK, Zhang ZX, and Li ZJ contributed to data collection and investigation; Fu F and Yu XY contributed to manuscript writing, reviewing, and editing.

Supported by the Shanghai Municipal Commission of Health and Family Planning, No. PKJ2018-Y05.

Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report.

Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Xiao-Yu Yu, PhD, Associate Chief Technician, Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, No. 1800 Yuntai Road, Pudong District, Shanghai 200123, China. flyyuxx@163.com

Received: March 9, 2024
Revised: August 13, 2024
Accepted: September 14, 2024
Published online: October 27, 2024
Processing time: 225 Days and 11.1 Hours

Abstract

BACKGROUND

Occult hepatitis B infection (OBI) is characterized by the detection of hepatitis B virus (HBV) DNA in serum (usually HBV DNA < 200 IU/mL) or the liver but negativity for hepatitis B surface antigen (HBsAg). The diagnosis of OBI relies on the sensitivity of assays used in the detection of HBV DNA and HBsAg. HBsAg assays with inadequate sensitivity or inability to detect HBV S variants may lead to misdiagnosis of OBI in people with overt HBV infection.

CASE SUMMARY

We report a HBsAg-negative but hepatitis B envelope antigen-positive patient who had a significant HBV DNA level. The patient was initially diagnosed as having OBI. However, sequence analysis revealed a unique insertion of amino acid residues at positions 120-124 in the S protein, which affects the formation of a disulfide bond that is associated with the formation of a loop. It is well known that there is an overlap between the S protein and Pol protein. We found that this new insertion site occurred in polymerase/reverse transcriptase domain, indicating that this insertion might be involved in HBV pathogenicity. The patient was finally diagnosed with a false OBI.

CONCLUSION

An insertion of amino acid residues at positions 120-124 of the S protein affects the formation of immunodominant epitopes and results in negative HBsAg levels.

Keywords: Occult hepatitis B infection; Hepatitis B virus; Hepatitis B surface antigen; Hepatitis B envelope antigen; Immunodominant epitopes; Case report

Core Tip: We report a hepatitis B surface antigen-negative but hepatitis B envelope antigen-positive patient who had a significant hepatitis B virus (HBV) DNA level. The patient was initially diagnosed as having OBI. However, sequence analysis revealed a unique insertion of amino acid residues at positions 120-124 in the S protein, which affects the formation of a disulfide bond that is associated with the formation of a loop. It is well known that there is an overlap between the S protein and Pol protein. We found that this new insertion site occurred in polymerase/reverse transcriptase domain, indicating that this insertion might be involved in HBV pathogenicity. The patient was finally diagnosed with a false OBI.