Case Report
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Apr 7, 2009; 15(13): 1650-1652
Published online Apr 7, 2009. doi: 10.3748/wjg.15.1650
A combination treatment of entecavir and early-phase corticosteroid in severe exacerbation of chronic hepatitis B
Kazuyuki Matsumoto, Yasuhiro Miyake, Hirokazu Miyatake, Masahiro Takahara, Takayuki Imada, Satoru Yagi, Tatsuya Toyokawa, Morihito Nakatsu, Masaharu Ando, Mamoru Hirohata
Kazuyuki Matsumoto, Hirokazu Miyatake, Masahiro Takahara, Takayuki Imada, Satoru Yagi, Tatsuya Toyokawa, Morihito Nakatsu, Masaharu Ando, Mamoru Hirohata, Department of Internal Medicine, Mitoyo General Hospital, Kanonji 769-1695, Japan
Yasuhiro Miyake, Department of Molecular Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558, Japan
Author contributions: Matsumoto K and Miyake Y analyzed the data and wrote the paper; Miyatake H, Takahara M, Imada T, Yagi S, Toyokawa T, Nakatsu M carried out patient care; Ando M and Hirohata M helped by supervising and approving the final manuscript.
Correspondence to: Yasuhiro Miyake, MD, Department of Molecular Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558, Japan. miyake43@md.okayama-u.ac.jp
Telephone: +81-86-2357219
Fax: +81-86-2255991
Received: December 8, 2008
Revised: February 9, 2009
Accepted: February 16, 2009
Published online: April 7, 2009
Abstract

Of patients with severe exacerbation of chronic hepatitis B accompanied by jaundice and coagulopathy, 20%-30% have a fatal outcome. In this report, we describe 2 cases of severe exacerbation of chronic hepatitis B with jaundice and coagulopathy who were successfully treated with a combination of entecavir and corticosteroid. In both cases, rapid reductions in serum hepatitis B virus (HBV)-DNA levels were observed, and corticosteroid was stopped after serum HBV-DNA levels became undetectable. Entecavir treatment was continued. Generally, entecavir treatment reduced serum HBV-DNA levels rapidly, although the improvement in liver function was delayed by a few weeks. During this time lag, liver cell injury continued and the disease progressed. Corticosteroid suppressed the excessive host immune response and was useful for stopping progressive deterioration. A combination of entecavir and early-phase corticosteroid may be a useful treatment in severe exacerbation of chronic hepatitis B.

Keywords: Acute exacerbation; Chronic hepatitis B; Corticosteroid; Entecavir; Hepatitis B virus; Hepatic coma