利妥昔单抗致华氏巨球蛋白血症患者乙型肝炎病毒再激活一例

Hepatitis B virus reactivation caused by long-term administration of rituximab in a patient with waldenstrom macroglobulinemia:a case report

本文报道1例患有华氏巨球蛋白血症、单纯HBsAb阳性的96岁男性患者,长期规律静脉滴注利妥昔单抗,在随访过程中发现HBsAg血清学逆转、HBV-DNA转阳和肝功能异常。经医师全面排查,考虑为利妥昔单抗引起的HBV再激活,暂停静脉滴注利妥昔单抗,给予口服恩替卡韦抗病毒治疗、五酯胶囊保肝降酶治疗后病情稳定,避免了严重不良事件的发生。通过对本病例的分析,以期为利妥昔单抗的临床治疗提供参考。

This article reports a 96-year-old male patient with Waldenstrom macroglobulinemia and positive HBsAb only.The patient,who was on a regular intravenous rituximab regimen,showed serological reversal of HBsAg,HBV-DNA positivity,and abnormal liver function during follow-up.After comprehensive screen,physician judged it as the reactivation of hepatitis B virus caused by rituximab.Rituximab was discontinued,and the patient was treated with oral entecavir for antiviral therapy and wuzhi capsules for hepatoprotection and enzyme reduction.The patient's condition was stable and serious adverse events were avoided.The analysis of this case aims to provide a reference for rational use of rituximab.