pISSN 2287-2728 eISSN 2287-285X Case Report http://dx.doi.org/10.3350/cmh.2012.18.2.225 Clinical and Molecular Hepatology 2012;18:225-228 A fatal case of hepatitis B virus (HBV) reactivation during long-term, very-low-dose steroid treatment in an inac- tive HBV carrier Joong Ho Bae1, Joo Hyun Sohn1, Hye Soon Lee2, Hye Sun Park1, Yil Sik Hyun1, Tae Yeob Kim1, Chang Soo Eun1, Yong Cheol Jeon1, and Dong Soo Han1 1Divisions of Gastroenterology and 2Rheumatology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea Hepatitis B virus (HBV) may be reactivated after chemotherapy or immunosuppressive therapy, and therefore administration of antiviral agents before such treatment is recommended. Most reported cases of reactivation are associated with high doses of immunosuppressive agents or combination therapy. We present a case of a previously inactive HBV carrier with an acute severe flare-up during a long-term, very-low-dose (2.5 mg/day) steroid treatment for rheumatoid arthritis. We suggest that even a minimal dose of single-regimen oral steroid can cause reactivation of indolent, inactive HBV. (Clin Mol Hepatol 2012;18:225-228) Keywords: Hepatitis B virus; Liver failure; Steroids; Virus activation It is widely accepted that reactivation of hepatitis B virus (HBV) an acute severe flare-up during a long term very low dose steroid may occur along with an acute hepatitis after chemotherapy or treatment due to RA, which despite decreased viral activity after INTRODUCTION immunosuppressive therapy.1-3 Current recommendation is to give antiviral agents before starting these therapies.4-7 However, most of the reactivation cases are associated with high doses of im- munosuppressive agents including steroids or chemotherapeutic agents. Although there are some case reports of acute flare-up of HBV after high dose steroid therapy, there have been very few which low dose steroid is an essential part of prescription. We report a case of previously inactive 86-year-old HBV carrier with prompt initiation of antiviral therapy against HBV, ultimately led to progressive liver failure and death. CASE REPORT reports of acute severe flare-up after long-term administration of In September 2009, a 86-year-old Korean woman visited the low dose steroid in an inactive HBV carrier. Since a vast number of out-patient department complaining of recent development of patients are at some point in need of low dose steroid administra- both lower extremity and facial edema. Poor oral intake was tion, including most rheumatologic diseases such as rheumatoid evident for nearly a month, and she appeared chronically ill. She arthritis (RA), this will be of important concerns in those sectors was underweight with a body mass index of 18.2 (height 151 Abbreviations: DMARD, disease modifying antirheumatic drugs; HBV, hepatitis B virus; RA, rheumatoid arthritis; SAAG, serum ascites albumin gradient Corresponding author : Joo Hyun Sohn Division of Gastroenterology, Department of Internal Medicine, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471-701, Korea Tel. +82-31-560-2225, Fax. +82-31-555-2998, E-mail; sonjh@hanyang.ac.kr Received : December 13, 2010 Rev i s e d : September 20, 2011 Accepted : October 4, 2011 Copyright © 2012 by The Korean Association for the Study of the Liver This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.