Spontaneous Viral Reactivation without Immunosuppressive Treatment in Three Cases in Senegal and Literature Review

Abstract

Introduction : Hepatitis B reactivation is a rare complication of hepatitis B (HBV), which is often triggered by immunosuppressive therapy, however its occurrence can be spontaneous. Its prognosis is often unfavorable due to complications as of acute hepatitis, in particular fulminant hepatitis. Comments : Case 1: A 49-year-old male followed for hepatitis B virus-induced cirrhosis under Tenofovir 300 mg/d and, was admitted with cholestatic jaundice in whom the diagnosis of severe acute hepatitis secondary to hepatitis B reactivation was retained. However, apart from treatment interruption, there were no other contributing factors. Evolution was unfavorable with the onset of hepatic encephalopathy of which the patient succumbed. Case 2: A 40-year-old male known diabetic patient, followed for chronic inactive hepatitis B virus (HBV) carriage, was hospitalized for exploration of jaundice associated to physical asthenia, in whom the diagnosis of acute hepatitis secondary to viral reactivation B was retained; the etiological factors found in this patient were unmonitored diabetes and HIV infection. Evolution was favorable after tenofovir intake. Case 3. A 44-year-old male followed for HBV cirrhosis under no treatment, was admitted with ascites and jaundice in whom diagnosis of severe acute hepatitis secondary to viral reactivation B was retained. No contributing factor was found in the patient. He benefited from treatment based on Tenofovir 300 mg/day, but the evolution was unfavorable due to the onset of hepatic encephalopathy of which the patient succumbed. Conclusion : Hepatitis B reactivation is a rare and dreaded complication of HBV infection. It is often triggered by immunosuppressive therapy or acquired immunosuppression. However, it is important to consider that its occurrence can be spontaneous even in the absence of a contributing factor.