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We report a case of fatal liver failure due to reactivation oflamivudine-resistant HBV.A 53-year-old man was followedsince 1998 for HBV-related chronic hepatitis.Serum HBV-DNA was 150 MEq/mL (branched DNA signal amplificationassay) and ALT levels fluctuated between 50-200 IU/L withno clinical signs of liver cirrhosis.Lamivudine (100mg/d)was started in May 2001 and serum HBV-DNA subsequentlydecreased below undetectable levels.In May 2002,serumHBV-DNA had increased to 410 MEq/mL,along with ALTflare (226 IU/L).The YMDD motif in the DNA polymerasegene had been replaced by YIDD.Lamivudine was continuedand ALT spontaneously decreased to the former levels.OnOct 3 the patient presenting with general fatigue,nauseaand jaundice was admitted to our hospital.The laboratorydata revealed HBV reactivation and liver failure (ALT:1828IU/L,total bilirubin:10mg/dL,and prothrombin INR:3.24).For religious reasons,the patient and his family refusedblood transfusion,plasma exchange and liver transplantation.The patient died 10 d after admission.The autopsy revealedremarkable liver atrophy.
We report a case of fatal liver failure due to reactivation oflamivudine-resistant HBV. A 53-year-old man was followedsince 1998 for HBV-related chronic hepatitis. Serum HBV-DNA was 150 MEq / mL (branched DNA signal amplification assay) and ALT Levels fluctuated between 50-200 IU / L with no clinical signs of liver cirrhosis. Lamivudine (100 mg / d) was started in May 2001 and serum HBV-DNA subsequentlydecreased below undetectable levels.In May 2002, serum HBV-DNA had increased to 410 MEq / mL, along with ALTflare (226 IU / L). The YMDD motif in the DNA polymerase was had been replaced by YIDD. Lamivudine was continued and ALT spontaneously decreased to the former levels. Onct 3 the patient presenting with general fatigue, nausea and jaundice was admitted to our hospital. The laboratory has revealed HBV reactivation and liver failure (ALT: 1828 IU / L, total bilirubin: 10 mg / dL, and prothrombin INR: 3.24). For religious reasons, the patient and his family refused blood transfusion, plasma exchange and liver transplantation. The patient died 10 d after admission. The autopsy revealed markable liver atrophy.