Reactivation of chronic type B hepatitis presenting as acute viral hepatitis.

Three asymptomatic chronic carriers of hepatitis B surface antigen, who had normal serum aminotransferase levels and no detectable hepatitis B e antigen in serum, developed icteric, symptomatic acute hepatitis. Serologic evidence of acute infection with hepatitis A virus, delta hepatitis virus, cytomegalovirus, or Epstein-Barr virus was absent. However, hepatitis B virus DNA and DNA polymerase activity, which were not detectable before the exacerbation, appeared in the serum of all three patients during the acute illness, confirming the diagnosis of spontaneous reactivation of chronic type B hepatitis. Thus, acute exacerbations of chronic type B hepatitis may present as an acute hepatitis superimposed on the chronic carrier state.