Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2021; 9(5): 1196-1203
Published online Feb 16, 2021. doi: 10.12998/wjcc.v9.i5.1196
Negative conversion of autoantibody profile in chronic hepatitis B: A case report
Xun Zhang, Qin-Xiu Xie, Dong-Mei Zhao
Xun Zhang, Department of Infectious Disease, The Fourth Affiliated Hospital of Anhui Medical University, Hefei 230012, Anhui Province, China
Qin-Xiu Xie, Dong-Mei Zhao, Department of Infectious Disease, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Author contributions: Zhang X collected primary data, searched the literature and drafted the manuscript; Xie QX performed percutaneous liver puncture and organized pathological images; Zhao DM contributed to reviewing the manuscript, data analysis and preparation of tables; All authors have read and approve the final manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong-Mei Zhao, PhD, Attending Doctor, Doctor, Department of Infectious Disease, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230022, Anhui Province, China. zdm5460@163.com
Received: October 27, 2020
Peer-review started: October 27, 2020
First decision: November 26, 2020
Revised: December 9, 2020
Accepted: December 22, 2020
Article in press: December 22, 2020
Published online: February 16, 2021
Abstract
BACKGROUND

Autoimmune antibodies are detected in many diseases. Viral infections are accompanied by several immunopathological manifestations. Some autoimmune antibodies have been associated with the immune response induced by virus or drugs. Thus, a comprehensive diagnosis of chronic hepatitis B combined with autoimmune hepatitis is required, and immunosuppressant or antiviral therapy should be carefully considered.

CASE SUMMARY

We present a case of a patient who had negative transformation of autoimmune antibodies during chronic active hepatitis B. A 50-year-old female who had a history of asymptomatic hepatitis B virus carriers for more than 10 years presented to the hospital with the complaint of weakness for 1 wk. Blood tests revealed elevated liver enzymes; the detection of autoantibodies was positive. Hepatitis B viral load was 72100000 IU/mL. The patient started tenofovir alafenamide fumigate 25 mg daily. Liver biopsy was performed, which was consistent with chronic active hepatitis B. The final diagnosis of the case was chronic active hepatitis B. The autoimmune antibodies turned negative after 4 wk of antiviral therapy. The patient recovered and was discharged with normal liver function. There was no appearance of autoantibodies, and liver function was normal at regular follow-ups.

CONCLUSION

Autoimmune antibodies may appear in patients with chronic active hepatitis. It is necessary to differentiate the diagnosis with autoimmune hepatitis.

Keywords: Autoantibodies, Autoimmune hepatitis, Chronic hepatitis B, Immune responses, Case report

Core Tip: This case involved dynamic changes in autoantibodies in the pathogenesis of hepatitis B. The patient showed positive hepatitis B surface antigen, which can cause an autoimmune phenomenon during the clearance of hepatitis B virus (HBV). Liver pathology was performed to differentiate from autoimmune hepatitis. It is possible that the virus has a role in inducing immune responses in HBV infection. This is closely related to hepatocyte injury caused by HBV infection, which is mainly mediated by immunity. Autoantibodies can appear during viral hepatitis, and the combination of liver pathology and dynamic monitoring is required.