Spontaneous reactivation of hepatitis B virus with S gene mutations in an elderly patient with diabetic nephropathy

Noriyuki Obara, Jun Inoue, Hiroyuki Endo, Eiji Kakazu, Masashi Ninomiya, Tomoaki Iwata, Akitoshi Sano, Mio Tsuruoka, Atsushi Masamune

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Generally, reactivation of hepatitis B virus (HBV) infection is induced by the administration of immunosuppressants or anticancer agents, but reactivation without such drugs has rarely been reported. Here we report an elder case with spontaneous reactivation of HBV replication accompanied by hepatitis B surface antigen (HBsAg) mutations. A 69-year-old man with a history of diabetes mellitus and chronic kidney disease (CKD) was found to be positive for HBsAg (0.072 IU/ml) in June 2018. In May 2019, marked hepatic dysfunction and increased HBsAg (2533.2 IU/ml) were observed when he visited the hospital due to diarrhea and worsening of CKD. At that time, hepatitis B surface antibody (HBsAb) was positive (268.9 mIU/ml) and HBV DNA was 6.0 log IU/ml. After treatment with entecavir, HBV DNA and HBsAg rapidly decreased. Full-genome HBV sequence analysis revealed that the patient was infected with HBV of subgenotype B1 and it had an “a” determinant mutation M133L in the S gene coding HBsAg. Notably, both HBsAg and HBsAb were positive at the time of HBV reactivation, suggesting that the HBV with these mutations escaped from neutralization by HBsAb. This case suggests that immune escape mutations could play an important role in spontaneous HBV reactivation.

Original languageEnglish
Pages (from-to)914-919
Number of pages6
JournalClinical Journal of Gastroenterology
Issue number5
Publication statusPublished - 2020 Oct 1


  • CKD
  • HBV
  • Immune escape
  • M133L

ASJC Scopus subject areas

  • Gastroenterology


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