Successful lamivudine therapy for post-chemotherapeutic fulminant hepatitis B in a hepatitis B virus carrier with non-Hodgkin's lymphoma: case report and review of the literature.

Reactivation of hepatitis B virus (HBV), especially after withdrawal of corticosteroids is a well-known complication during chemotherapy for lymphoma. The high mortality makes this complication one of the major obstacles to completing the standard treatment for lymphoma in HBV carriers. We report a 58-year-old Japanese male HBV carrier who developed fulminant hepatitis after chemotherapy with cyclophosphamide and doxorubicin. Lamivudine was introduced since his hepatitis was progressive under supportive treatment and showed an elevated level of HBV DNA. After initiation of lamivudine, HBV DNA decreased to be below the limit of detection within 3 weeks, and all chemical tests for liver function recovered to the normal level within 4 weeks, except for a slight elevation of total-bilirubin. There were no remarkable adverse effects observed. To the best of our knowledge, six cases of post-chemotherapeutic fulminant hepatitis including ours have been treated with lamivudine. A review of these cases indicated that lamivudine induced a prompt antiviral, biochemical, and clinical response. Lamivudine is highly recommended for post-chemotherapeutic fulminant hepatitis caused by reactivation of HBV.