Muhammet Fatih TOPUZ, Serdar GÜL, Muhammet GÜLHAN, Pınar YILDIZ GÜLHAN, Olgun ÖZTÜRK

Sirozlu hastada HBsAg/Anti-HBs serokonversiyonu

Kronik hepatit B, siroz ve hepatoselüler kanser gibi ciddi ve ölümcül hastalıklara neden olabilir. Kronik hepatit B hastalarında genellikle HBsAg varlığını devam ettirir. Spontan ya da tedavi altında Anti-HBs serokonversiyonu nadir de olsa görülebilir ve tedavi altında ise tedaviyi sonlandırma kriteri olarak düşünülür. Bu olgu sunumunda, Anti-HBs pozitifliği olan ancak siroz olduğunu bilmeyen 63 yaşındaki erkek hastadan bahsedilmiştir. Hasta polikliniğimize uzun yıllardır yaptırmadığı takiplerine tekrar başlamak için başvurdu. İlk muayenesinde 20 yıldır hepatit B hastası olduğu ve 2 yıl tedavi aldığı sonrasında takiplerini bıraktığı öğrenilmiştir. Fizik muayenesi normal olan hastanın yapılan kan tahlillerinde Anti-HBs'nin pozitif olduğu ve trombositopenisi olduğu tespit edilmiştir. Hastanın yapılan radyolojik incelemelerinde batın ultrasonografi (USG) bulgularının siroz ile uyumlu olduğu görülmüştür. Anti-HBs pozitif olan hastanın siroz etiyolojisi açısından incelemek amacıyla özgeçmişi irdelendiğinde; 19 yıl önce yapılan biyopsinin siroz olarak rapor edildiği görülmüştür. Hastanın siroz nedeninin hepatit B olduğu ve siroz hastalığı geliştikten sonra HBsAg/Anti-HBs serokonversiyonu oluştuğu anlaşılmıştır. Daha önce interferon tedavisi alan ve HBV-DNA'sı düşük titre de pozitif olarak devam eden hastaya tenefovir tedavisi başlanmıştır. Siroz etiyolojisi araştırılan hastalarda Anti-HBs pozitifliği klinisyeni Hepatit B hastalığından uzaklaştırabilir. Hikayesi derinleştirilmeyen hastalar yanlış tanı konulmasına neden olabilir. Siroz etiyolojisi araştırılan hastalarda herhangi bir neden bulunamazsa ve hasta Anti-HBs pozitif ise HBV-DNA testi yapılması akılda tutulmalıdır. Literatürde benzer şekilde siroz hastalığı geliştikten sonra HBsAg/Anti-HBs serokonversiyonu görülen hasta ile ilgili yayın bulunmadığından bu olgu sunulmuştur

HBsAg/Anti-HBs seroconversion in cirrhotic patient

Chronic hepatitis B infection can lead to serious and mortal illnesses such as cirrhosis and hepatocellular carcinoma. HBsAg usually persists in chronic Hepatitis B patients. Spontaneous or being treated Anti-HBs seroconversion can be rarely observed and considered to be the endpoint of treatment if he is being trated. In this case study, it is mentioned that 63 years old patient who does not know that he has cirrhosis but Anti-HBs positive. The patient applied to our clinic to take some regular follow-ups which have not been taken for many years. In his first examination it was learned that the patient has been hepatises positive for 20 years and stopped follow-ups after taking two years medical treatment. The patient’s whose physical examination is normal and it was detected that Anti-HBs pozitive and thrombocytopenia in blood tests. It was show that abdominal ultrasonography findings conform with cirrhosis. When it was investigated patient’s earlier results with Anti-HBs positive to search in terms of cirrhosis etiology, his previous biopsy was reported as cirrhosis 19 years ago. The causes cirrhosis is hepatitis be HBsAg /Anti-HBs seroconversion developed after cirrhosis. The tenofovir treatment was started to patient who has low titer HBV DNA and treated with interferon previously. The Anti-HBs positivity can detract the specialists from hepatitis B infection when cirrhosis etiology is investigatedin patients. The patient whose previous anamnesis was not detailed can be misdiagnosis. HBVDNA test should considered when the cirrhosis etiology is investigated in Anti-HBs positive patient with cirrhosis. It was presented this case because there is no HBsAg/Anti-HBs seroconversion after cirrhosis published before.

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