Case Report

Death from Liver Failure despite Lamivudine Prophylaxis during R-CHOP Chemotherapy due to Rapid Emergence M204 Mutations

Table 1

Basic characteristics and summary of cases.

CharacteristicsCase  1Case  2

Age (years)6550
SexMaleMale
EthnicityChineseChinese
HBV status before chemotherapyHBeAg negative,
Anti-HBe positive, HBV DNA 6.65E5 IU/mL, ALT 43 IU/L
HBeAg negative,
Anti-HBe positive, HBV DNA 8.90E4 IU/mL*, ALT 37 IU/L
Prior hepatitis B treatmentNoNo
Clinical evidence of advanced liver fibrosisAbsentAbsent
Fibrosis stageFibroscan 4.4 KPa (F0)APRI 0.19 (F0-1)
ComorbiditiesHypothyroid, hypertension, latent tuberculosis infectionGout, psoriasis
Medications usedLevothyroxine, valsartan, isoniazid, pyridoxine, metforminCalcipotriol/betamethasone ointment, Chinese herbal tea
Diffuse, large B-cell lymphoma stageStage IIAStage III
Lymphoma treatmentR-CHOP x 6R-CHOP x 6
Lamivudine start date8 days after first chemotherapy4 days after first chemotherapy
HBV DNA after 2 months of LAM treatment2.18E1 IU/mL3.96E3 IU/mL
Time of HBV reactivation diagnosis18 weeks after R-CHOP number 67 weeks after R-CHOP number 6
Duration of LAM at HBV reactivation7 months7 months
Lamivudine resistance patternL80I, M204IL80I, M80V, M204V/S
HBV status at reactivationHBeAg negative, anti-HBe positive, HBV DNA 1.43E7 IU/mL, ALT 1019 IU/LHBV DNA 1.02E8 IU/mL, ALT 902 IU/L
Time to death despite tenofovir treatment14 days3 days

HBV DNA at 24 days after starting lamivudine. No baseline HBV DNA was done before lamivudine treatment.