A 69-year-old man with a history of stage D2 prostate adenocarcinoma with multiple bone metastases who had received a month and a half earlier chemotherapy treatment with mitoxontrone and prednisone with clinical and analytical response. His personal history included surgery for a pulmonary hydatid cyst 50 years ago that required transfusion of blood products, left iliofemoral bypass in 1991 due to chronic arterial ischaemia and a 3 cm abdominal aortic aneurysm under follow-up.
He was admitted for asthenia, anorexia, pruritus and mucocutaneous jaundice, with choluria and acholia of two weeks' evolution. Physical examination revealed mucocutaneous jaundice, hepatomegaly at about 23 cm of the right costal margin, painful on deep palpation, without peritonism.
Blood tests showed: Hb 13.5, leukocytes 3,900 (lymphocytes 53%), platelets 159.000, prothrombin activity 53%, INR 1.58, fibrinogen 221, cephalin time 42.9, urea 38, creatinine 0.8, glucose 110, total protein 6.3, GOT 904, GPT 990, total bilirubin 10.7 (direct 7.2), GGT 399, alkaline phosphatase 349, LDH 905. HIV serology negative. HAV IgM negative, HBsAg+, antiHBs-, lgM anticore+, HBeAg+ and antiHBe-. HCV markers negative. HBV DNA positive.

Abdominal ultrasound showed no relevant findings except for a normal sized liver with diffusely increased echogenicity without focal lesions, vascular permeability or signs of portal hypertension.
An uncomplicated transjugular liver biopsy was performed and the diagnosis was acute hepatitis of viral aetiology, with regenerative changes and mild portal fibrosis. There were areas of hepatocyte collapse and bridging necrosis.
Given the high probability of fulminant hepatic failure due to his underlying disease, it was decided to administer adefovir dipivoxil on a compassionate use basis for the control of acute viral hepatitis. After initiation of treatment, the patient experienced a favourable clinical course with progressive normalisation of liver function. HBV DNA was negative two months after the start of treatment.
Three months after treatment, the control analysis showed a total bilirubin of 1.1, GOT 36, GPT 25, GGT 72 FA 426, and second-line chemotherapy treatment with docetaxel could begin due to elevated PSA and reappearance of pain in the dorsal spine and right shoulder.

