Age: 35.0
Sex: M
Vaccine: HEP
Symptoms: Hepatitis B DNA assay, Hepatitis B DNA decreased, Hepatitis B DNA increased, Hepatitis B core antigen, Hepatitis B e antigen
Clinical narrative: Information has been received from a physician concerning a patient who was vaccinated with two completed series of RECOMBIVAX HB (Manufacturer unknown). The physician stated that the patient had had negative anti-HBs testing on multiple occasions as was HepBSAg and Anti-HBc. On 15-SEP-2010, the patient was noted to have elevated serum aspartate aminotransferase test (AST) and plasma alanine aminotransferase test (ALT) on routine lab draw. Hepatitis serologies were sent on 13-OCT-2010, including Hepatitis B viral load. All Hepatitis B-serologies were negative (HepBSAg, HepBEAg, anti-HBs, anti-HBc, anti-Hbe), but hepatitis B viral load was positive. Elevated AST and ALT had resolved, on an unspecified date. Follow-up labs, including Hepatitis B genotype, were pending to evaluate for possible occult Hepatitis B infection. Follow up information has been received from a physician concerning the 35 year old male patient with allergic rhinitis, anxiety disorder, aphthous ulcer, asthma, atrial fibrillation, blurry vision, congestive heart failure (EF 20% February 2010, 01-MAR-2010), excessive sweating, HIV infection, hypertension, hypogonadism, joint pain fingers, left bundle branch block, left heart failure (EF 45%, 23-SEP-2009), left ventricular thrombosis (February 2010), male erectile disorder, obstructive sleep apnoea, seborrhoeic dermatitis, sleep disturbance, snoring, testes swelling tender, vitamin D deficiency, family history of diabetes and hypertension, and a history of alcohol and drug use, tachycardia while on therapy with albuterol AERS, rash while on therapy with ANDRODERM and swelling while on therapy with penicillin. Concomitant therapy included ibuprofen, chlorhexidine gluconate, ketoconazole, ketoconazole, hydrocortisone, BYSTOLIC, ramipril, TRUVADA, ISENTRESS, digoxin, azithromycin, LASIX, LUNESTA, vitamin D (unspecified) and clonazepam. The physician mentioned that the patient was seen for follow-up for 4 main issues. The patient had a penicillin injection after exposure to syphilis. The patient's muscles "seized up and became tight", and tendons ached and he had to take 1 1/2 KLONOPIN to get them to calm down. The patient also noted palpitations and feeling light-headed, this had resolved. Also developed pustular rash in left axilla. He used HIBICLENS and BACTROBAN on the area and then cut blisters open with scissors so they would drain. This resolved in yellow purulent drainage. The rash was resolving at the time of the report. The patient denied involvement of any other body area. Denied any ulcers/lesions on mucosal surfaces. The patient was exposed to syphilis via oral and anal sex (giving and receiving). The patient also visited the physician for Hepatitis B viraemia in the setting of LFT (liver function tests) abnormalities. The patient stated that his mother had Hepatitis B virus (HBV) as a child and was a carrier, he wondered if this was related. The patient did not know if he was ever tested for hepatitis B infection as a child. In response, the physician suspected occult HBV infection. All Hepatitis B serologies were negative. The following tests performed on 13-OCT-2010 were non-reactive: Hepatitis B surface antibody QL, Hepatitis BE antibody, Hepatitis B surface antigen and Hepatitis B core AB total. That same day, Hepatitis B viral DNA was 88 and Hepatitis B viral DNA copies was 512. The method used was Real-Time PCR of the pre-core region of the circular HBV genome. Repeated HBV VL (viral load) on 21-OCT-2010 was negative. Results suggested that either lab error or episode of transient viremia that had resolved. The patient was also concerned regarding low CD4 and poor response to ARV (anti-retroviral therapy). In response, the physician stated that although CD4 response had not been ideal, CD4 was >200 and viral load was undetectable, which was the current goal of therapy. The physician would not recommend changing current ART as the patient was responding well and tolerating regimen. The patient was concerned because blood pressure was elevated, which was atypical for him. In response, the physician stated that a re-check verified the result. The physician asked the patient to check his blood pressure over the next several days and inform about the results. The patient reported that his blood pressure had been checked three times in four days and each time was <120/80. The patient would continue current medication. The physical examination was within normal limits except for his skin, which was erythematous and there was macular rash in left axilla. Review of systems was within normal limits except for muscle pain and rash. Additional information is not expected.