A 69-year-old male with a history of stage D2 prostate adenocarcinoma with multiple bone metastases who had received chemotherapy with mitoxontrone and prednisone for one and a half months with clinical and analytical response.
Among the personal antecedents, emphasis was placed on pulmonary hydotid cyst follow-up 50 years ago that required transfusion of blood products, left iliofemoral bypass in 1991 for chronic arterial ischemia and abdominal aortic aneurysm of 3 cm.
She was admitted for a clinical picture of asthenia, anorexia, pruritus and mucocutaneous jaundice, with choluria and acholia of two weeks duration.
Physical examination revealed mucocutaneous jaundice, hepatomegaly of approximately 23 cm in the right costal margin painful to the deep rib without peritonitis.
Blood analysis showed: Hb 13.5, leukocytes 3900 (lymphocytes 53%), platelets 159,000, prothrombin activity 53% total, INR 1.58, fibrinogen 221, cefalin time 110GT 49, alkaline urea 999.
Serology HIV negative.
IgM HAV negative, HBsAg+, antiHBs-, lgM anticore+, HBeAg+ and antiHBe-.
HCV-negative markers.
HBV DNA positive.
1.
Abdominal ultrasound showed no relevant findings except for liver of normal size with diffusely increased echogenicity without focal lesions, vascular permeability or signs of portal hypertension.
A transjugular liver biopsy was performed without complications whose diagnosis was acute hepatitis of viral etiology, with regenerative changes and mild portal fibrosis.
There were areas of hepatocyte collapse and bridging necrosis.
Given the high probability of fulminant liver failure due to the underlying disease, it was decided to administer adefovir dipivoxil by compassionate use for the control of acute viral hepatitis.
After initiation of treatment, the patient experienced a favorable clinical course with progressive normalisation of liver function.
HBV DNA was negative two months after the start of treatment.
After 3 months of treatment the control analysis showed a total bilirubin of 1.1, GOT 36, GPT 25, GGT 72 FA 426, and can start second-line chemotherapy with docetaxel for elevation of the right shoulder and reappearance.
