Ann Rheum Dis 64:788-789 doi:10.1136/ard.2004.031187
  • Letter

Reactivation of a latent precore mutant hepatitis B virus related chronic hepatitis during infliximab treatment for severe spondyloarthropathy

  1. D Wendling1,
  2. B Auge1,
  3. D Bettinger2,
  4. A Lohse1,
  5. G Le Huede1,
  6. S Bresson-Hadni3,
  7. E Toussirot1,
  8. J-P Miguet3,
  9. G Herbein2,
  10. V Di Martino3
  1. 1Service de Rhumatologie, Centre Hospitalier Universitaire, F-25030 Besançon, France
  2. 2Laboratoire de Virologie, Centre Hospitalier Universitaire, F-25030 Besançon, France
  3. 3Service d’Hépatologie, Centre Hospitalier Universitaire, F-25030 Besançon, France
  1. Correspondence to:
    Professor D Wendling
    Department of Rheumatology, Jean Minjoz Hospital, University Teaching Centre, F-25030 Besançon, France;
  • Accepted 24 September 2004

We report a case of hepatitis B virus (HBV) reactivation following the use of anti-tumour necrosis factor α (TNFα) antibodies that illustrates the need for careful viral monitoring and pre-emptive antiviral treatment in such patients.


A 35 year old white woman presented with a history of chronic hepatitis B without an increase in serum alanine aminotransferase (ALT) or detectable HBV DNA by a hybridisation technique since its diagnosis (in 1993); she was thus considered to be an asymptomatic HBV carrier. Her serological status was as follows: hepatitis B surface antigen positive, hepatitis B e antigen negative, hepatitis B e antibody positive, suggesting HBV precore mutant. Her rheumatological history began in September 2001 with oligoarthritis, inflammatory low back pain, limitation of motion, and anterior chest wall involvement. Symptoms improved incompletely with non-steroidal anti-inflammatory drugs. Biological inflammation (erythrocyte sedimentation rate 62 mm/1st h, C reactive protein 53 mg/l), positive HLA-B27 …