Spontaneous reactivation of chronic hepatitis B infection leading to fulminant hepatic failure. Report of two cases and review of the literature.

Reactivation of chronic hepatitis B viral (HBV) infection, defined as conversion from the low level replicative phase (HBV-DNA negative) to the high level replicative phase (HBV-DNA positive) with continued hepatitis B surface antigen positivity, occurs after immunosuppressive therapy, chemotherapy, and rarely spontaneously. Development of hepatic failure after spontaneous reactivation of chronic HBV is rare. We report two patients with chronic HBV infection and stable cirrhosis in whom spontaneous reactivation lead to hepatic failure. In one, spontaneous reactivation lead to severe jaundice, ascites, and encephalopathy. Treatment with alpha-interferon resulted in transient improvement, but the patient ultimately died with hepatorenal syndrome. In the second, severe liver failure required orthotopic liver transplantation. Spontaneous reactivation is an unusual cause of hepatic decompensation in patients with chronic HBV infection and may lead to fulminant hepatic failure. The role of interferon or liver transplantation in the management of spontaneous reactivation remains to be clarified.