Seroconversion of HBsAG coincides with hepatitis A super-infection: A case report

doi:10.12998/wjcc.v8.i9.1651

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. May 6, 2020; 8(9): 1651-1655
Published online May 6, 2020. doi: 10.12998/wjcc.v8.i9.1651

Seroconversion of HBsAG coincides with hepatitis A super-infection: A case report

Claudia Beisel, Marylyn M Addo, Julian Schulze zur Wiesch

Claudia Beisel, Marylyn M Addo, Julian Schulze zur Wiesch, Department of Internal Medicine, Division of Infectious Disease, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany

Claudia Beisel, Marylyn M Addo, Julian Schulze zur Wiesch, German Center for Infection Research, Hamburg 20251, Germany

Author contributions: Beisel C was the patient’s doctor in charge and was responsible for collecting medical history, reviewing the literature, and drafting the paper; Schulze zur Wiesch J was the patient’s doctor in charge; Schulze zur Wiesch J and Addo MM reviewed the literature and made contribution to revising the manuscript; all authors issued final approval for the version to be submitted.

Informed consent statement: In the presented case blood tests led to our diagnosis. No invasive diagnostic procedures were performed; accordingly no informed consent was required.

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

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: Julian Schulze zur Wiesch, MD, Assistant Professor, Department of Internal Medicine, Division of Infectious Disease, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20251, Germany. German Center for Infection Research (DZIF), Hamburg, Germany. j.schulze-zur-wiesch@uke.de

Received: February 5, 2020
Peer-review started: February 5, 2020
First decision: February 27, 2020
Revised: March 26, 2020
Accepted: April 17, 2020
Article in press: April 17, 2020
Published online: May 6, 2020
Processing time: 85 Days and 2.9 Hours

Abstract

BACKGROUND

Hepatitis B virus (HBV) is a hepatotropic virus that can cause acute and chronic liver damage. According to the world health organization 257 million people are infected with chronic HBV infection worldwide. Super-infection with other hepadnaviruses, including hepatitis A virus (HAV), hepatitis C virus, hepatitis D virus, and hepatitis E virus is associated with increased risk of acute liver failure in patients with chronic HBV.

CASE SUMMARY

Here, we report a case of a 47-year old male patient with HBV-related compensated Child A cirrhosis, who presented with general fatigue, malaise and laboratory signs of acute hepatitis. Although the patient was regularly seen at a specialized university liver unit, the HAV vaccination status was unclear. Acute HAV super-infection was diagnosed by positive serological and polymerase chain reaction analysis. Following acute HAV super-infection, spontaneous HBsAg elimination and development of an anti-HBs titer were observed.

CONCLUSION

This case illustrates the importance of carefully checking the vaccination status. In our patient, unspecific immunological responses to HAV led to functional cure of HBV.

Keywords: Chronic hepatitis B infection; Liver cirrhosis; Acute hepatitis A infection; HBsAg clearance; Functional cure; Case report

Core tip: In patients with chronic hepatitis B virus (HBV) infection, super-infection with other hepatotropic viruses can lead severe liver diseases with acute on chronic liver failure, underlying the need to check for a complete hepatitis A virus (HAV) vaccination status. Here, we present an unvaccinated patient with HBV related liver cirrhosis who experienced an acute HAV super-infection. HAV infection was spontaneously cleared without signs of acute liver failure. Furthermore, most likely to an unspecific immunological response functional cure of HBV was observed (seroconversion of HBsAg to anti-HBs).