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.

CASE REPORT

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 …