| Autor: |
Freitas, Raquel, Lopes, Jorge, Godinho, Fátima, Cordeiro, Ana, Canas da Silva, José António, Sousa, Sandra |
| Zdroj: |
Acta Reumatológica Portuguesa; 2019 Special Issue, p167-168, 2p |
| Abstrakt: |
Background: Prior to initiating immunosuppressive therapy in autoimmune systemic disease, it is a requirement to screen for viral serology such as hepatitis B (HBV). Therapeutic intravenous immunoglobulins (IVIg) can transmit clinically important molecules. The passive transfer of antibodies from IVIg has been previously reported, but with limited awareness. As so, passive antibody transfer may not be routinely consi - dered in the interpretation of viral serology results after IVIg administration. Objectives and Methods: We report a case of a 70-year-old female patient with granulomatosis with polyangiitis (GPA) with passive anti-HBV surface antibody transfer following IVIg infusions. Results: We report a case of a 70-year old female patient diagnosed with GPA. She presented at the emergency department with fever, anemia, acute renal fai - lure, pulmonary infiltrates, bilateral sensorineural hearing loss and mononeuritis multiplex. She started treatment with corticosteroids and Rituximab (RTX). The viral serology was screened before initiating biologic Disease-modifying Antirheumatic Drug (bDMARD) and were negative, including hepatitis B core antibody (anti-HBc) and hepatitis B surface antigen (HBsAg) and surface antibody (HBsAc). After 6 months she was started on IVIg monthly infusions due to persistent and very symptomatic mononeuritis multiplex. After the fifth IVIg infusion and due to persistent disease activity, a second RTX cycle was scheduled and viral screening repeated. The screening revealed detectable anti-HBc and anti-HBs antibodies in the absent of HBsAg. She had no identifiable source of HBV infection, normal liver function tests and was negative for HBV viral load. It was unlikely that the patient had asymptomatically acquired and cleared hepatitis B infection in the period between the two laboratory tests. Therefore the possibility that anti-HBc appeared due to passive acquisition from IVIg therapy was considered. The acknowledgment that HBV antibodies are transmitted to patients through IVIg has been described in some case reports (1) and one cross sectional study with 80 patients receiving IVIg (2). In that study, 70 patients tested positive for anti-HBs and 36 for anti-HBc after IVIg. There was a progressive increase with each infusion in the percentage of patients testing positive for anti-HBc among patients newly commencing IVIg, and some patients "seroreverted" to negative during therapy. Conclusion: Passive transfer of anti-HBc can be a consequence of the administration of IVIg and does not represent an infection risk. Increased awareness and active consideration of the passive transfer of clinically significant antibodies from IVIg treatments will help prevent unnecessary procedures, antiviral therapy and withholding of essential immunosuppressive agents. [ABSTRACT FROM AUTHOR] |
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