Hepatitis B virus infection: Current status

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Presentation transcript:

Hepatitis B virus infection: Current status Ponsiano Ocama, MD, Christopher K. Opio, MD, William M. Lee, MD  The American Journal of Medicine  Volume 118, Issue 12, Pages 1413.e15-1413.e22 (December 2005) DOI: 10.1016/j.amjmed.2005.06.021 Copyright © 2005 Elsevier Inc. Terms and Conditions

Figure 1 Overwhelming hepatitis B infection with immunosuppression. Photomicrographs providing evidence that immunosuppression leads to overwhelming infection. A–D: Liver biopsy from a patient who developed severe liver failure after chemotherapy for non-Hodgkin lymphoma, which was ultimately fatal. A: Extensive hepatocyte injury and inflammation involving the portal tract and hepatic lobule. Prominent ground glass cytoplasmic inclusions representing excess HBsAg are present (100× hematoxylin-eosin). B: Severe architectural disruption with intercellular fibrosis and hepatocyte necrosis (fibrosing cholestatic hepatitis) (100× Masson trichrome stain). C: Immunohistochemical stain for HBsAg confirming the overwhelming burden of HBsAg giving diffuse cytoplasmic reactivity in virtually all cells (alkaline phosphatase stain 100×). D: Overwhelming infection is also evident with HBcAg-positive staining in virtually every nucleus and in cytoplasm as well (alkaline phosphatase stain 200×). E, F: In contrast, the same immunohistochemical stains observed above applied to the liver biopsy of a patient with chronic hepatitis B. E: Only a single cell demonstrates immunoreactivity to HBsAg (alkaline phosphatase stain 400×). F: Scattered nuclei are reactive to staining for HBcAg (alkaline phosphatase stain 200×). The American Journal of Medicine 2005 118, 1413.e15-1413.e22DOI: (10.1016/j.amjmed.2005.06.021) Copyright © 2005 Elsevier Inc. Terms and Conditions

Figure 2 An algorithm for the management of chronic hepatitis B.19-22 HBV = hepatitis B virus; HBcAg = hepatitis B core antigen; HBsAg = hepatitis B surface antigen; ER = endoplasmic reticulum; cccDNA = covalently closed circular DNA. The American Journal of Medicine 2005 118, 1413.e15-1413.e22DOI: (10.1016/j.amjmed.2005.06.021) Copyright © 2005 Elsevier Inc. Terms and Conditions