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Spontaneous reactivation of hepatitis B virus with multiple novel mutations in an elderly patient with resolved hepatitis B virus infection

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Abstract

Spontaneous reactivation of the Hepatitis B virus (HBV) is rare in individuals with previously resolved infections. This report presents the case of a 71 year-old Japanese woman who experienced HBV reactivation without any prior immunosuppressive therapy or chemotherapy. Before the onset of liver injury, the patient was negative for hepatitis B surface antigen (HBsAg) but positive for hepatitis B surface antibody. She subsequently developed liver injury, with the reappearance of HBsAg and HBV DNA. The patient was successfully treated with tenofovir alafenamide, and prednisolone. Full-genome sequencing of HBV revealed subgenotype B1 without hepatitis B e-negative mutations in the precore and core promoter regions and 12 amino acid alterations in the pre-S1/S, P, and X genes. Notably, the S gene mutations D144A and K160N, which alter the antigenicity of HBsAg and potentially contribute to its reactivation, were identified. This case emphasizes the importance of vigilance for spontaneous reactivation of resolved HBV, highlighting the need for comprehensive genomic analysis to understand the associated virological intricacies.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Iwate, 028-3694, Japan

    Tokio Sasaki, Keisuke Kakisaka, Akio Miyasaka, Hidekatsu Kuroda & Takayuki Matsumoto

  2. Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Iwate, 028-3694, Japan

    Masao Nishiya & Naoki Yanagawa

  3. Division of Virology, Department of Infection and Immunity, School of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan

    Masaharu Takahashi & Hiroaki Okamoto

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  1. Tokio Sasaki
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  8. Masaharu Takahashi
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  9. Hiroaki Okamoto
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Contributions

Conceptualization: Tokio Sasaki, Akio Miyasaka. Investigation: Masaharu Takahashi, Hiroaki Okamoto. Writing-original draft: Tokio Sasaki. Writing, review, and editing: Keisuke Kakisaka, Akio Miyasaka, Masao Nishiya, Naoki Yanagawa, Hidekatsu Kuroda, Takayuki Matsumoto, Masaharu Takahashi, and Hiroaki Okamoto. Approval of final manuscript: All authors.

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Correspondence to Tokio Sasaki.

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All the authors declare that they have no conflict of interest.

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All the procedures were performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.

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Informed consent was obtained from the patient to publish the clinical and virological findings.

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Sasaki, T., Kakisaka, K., Miyasaka, A. et al. Spontaneous reactivation of hepatitis B virus with multiple novel mutations in an elderly patient with resolved hepatitis B virus infection. Clin J Gastroenterol (2024). https://doi.org/10.1007/s12328-024-01984-1

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  • DOI: https://doi.org/10.1007/s12328-024-01984-1

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