Reactivation of hepatitis B virus after glioblastoma treatment with temozolomide: Case report

Makoto Ohno, Yoshitaka Narita, Yasuji Miyakita, Hideki Ueno, Takamasa Kayama, Soichiro Shibui

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11 Scopus citations


A 61-year-old man with glioblastoma and positive for hepatitis B surface antigen (HBsAg) developed acute hepatitis due to hepatitis B virus (HBV) reactivation after concomitant postoperative treatment with temozolomide (75 mg/m2/day) and radiation therapy (60 Gy in 30 fractions). Corticosteroids were not used during chemo-radiation therapy, and grade 4 lymphocytopenia was observed. The levels of liver function tests (LFTs), including levels of aspartate aminotransferase and alanine aminotransferase, increased 5 weeks after the completion of chemo-radiation therapy, and reached the maximum levels of 1,549 IU/l (normal 13 to 33 IU/l) and 1,653 IU/l (normal 8 to 42 IU/l), respectively, after 2 weeks. At this point, serum HBV-deoxyribonucleic acid (DNA) level had increased to 630-fold over the baseline, and therapy with the antivirus agent entecavir (0.5 mg daily) was started. Over the next 2 weeks, the levels of LFTs and HBV-DNA improved. The present and previous cases suggest that grade 3/4 lymphocytopenia or grade 2 lymphocytopenia with corticosteroid use might have a significant effect on HBV reactivation. To avoid this complication, HBsAg-positive patients with glioblastoma should consult a hepatologist for initiating antivirus therapy before temozolomide treatment.

Original languageEnglish
Pages (from-to)728-731
Number of pages4
JournalNeurologia Medico-Chirurgica
Issue number10
StatePublished - 2011
Externally publishedYes


  • Glioblastoma
  • Hepatitis B virus
  • Immunosuppression
  • Reactivation
  • Temozolomide


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