Isolated HBsAg positivity in a Mexican patient with newly diagnosed lupus nephritis

Guillermo Delgado-García, Ilse Mandujano-Cruz, Kiber González-Padilla, Gabriela Alarcón-Galván, Miguel Ángel Villarreal-Alarcón, Dionicio Ángel Galarza-Delgado

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

© 2016 Egyptian Society for Joint Diseases and Arthritis Introduction Hepatitis B surface antigen (HBsAg) is usually regarded as a marker of hepatitis B virus (HBV) infection. The concurrence of lupus nephritis (LN) and HBsAg-positivity is a challenge for the clinician, since immunosuppressant use may be associated with an increase in viral replication and an exacerbation of liver disease. Case presentation Here, we describe the case of a 30-year-old Mexican woman with newly diagnosed focal proliferative LN who also tested repeatedly positive for HBsAg by chemiluminescent microparticle immunoassay (CMIA). She had no clinical features of hepatitis and her liver function tests were within normal limits. Her abdominal ultrasound was also normal. While waiting for further results, she was started on lamivudine (100 mg daily). However, total HBV core antibody test was negative. Owing to the infrequency of this serological pattern, an in vitro polymerase chain reaction (PCR) assay was performed and HBV was not detected. Overall, we interpreted these results as a false-positive screening. Methylprednisolone pulse therapy was subsequently given (1 g daily for three doses) without hepatic repercussion, neither clinically nor biochemically. Conclusions Isolated HBsAg positivity may result from multiple causes, one of which is cross-reactivity. To the best of our knowledge, this is the first report of a false-positive reading using CMIA technique in an active lupus patient. It is reasonable to stress that lupus patients with a positive screening for HBV should undergo a confirmatory assay (such as genomic detection), since this diagnosis may have important therapeutic implications.
Original languageEnglish
Pages (from-to)49-52
Number of pages4
JournalEgyptian Rheumatologist
DOIs
Publication statusPublished - 1 Jan 2017
Externally publishedYes

Fingerprint

Lupus Nephritis
Hepatitis B Surface Antigens
Hepatitis B virus
Immunoassay
Hepatitis B Antibodies
Lamivudine
Joint Diseases
Liver Function Tests
Methylprednisolone
Virus Diseases
Immunosuppressive Agents
Hepatitis
Arthritis
Liver Diseases
Reading
Polymerase Chain Reaction
Liver
Therapeutics

All Science Journal Classification (ASJC) codes

  • Rheumatology

Cite this

Delgado-García, G., Mandujano-Cruz, I., González-Padilla, K., Alarcón-Galván, G., Villarreal-Alarcón, M. Á., & Galarza-Delgado, D. Á. (2017). Isolated HBsAg positivity in a Mexican patient with newly diagnosed lupus nephritis. Egyptian Rheumatologist, 49-52. https://doi.org/10.1016/j.ejr.2016.02.007
Delgado-García, Guillermo ; Mandujano-Cruz, Ilse ; González-Padilla, Kiber ; Alarcón-Galván, Gabriela ; Villarreal-Alarcón, Miguel Ángel ; Galarza-Delgado, Dionicio Ángel. / Isolated HBsAg positivity in a Mexican patient with newly diagnosed lupus nephritis. In: Egyptian Rheumatologist. 2017 ; pp. 49-52.
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abstract = "{\circledC} 2016 Egyptian Society for Joint Diseases and Arthritis Introduction Hepatitis B surface antigen (HBsAg) is usually regarded as a marker of hepatitis B virus (HBV) infection. The concurrence of lupus nephritis (LN) and HBsAg-positivity is a challenge for the clinician, since immunosuppressant use may be associated with an increase in viral replication and an exacerbation of liver disease. Case presentation Here, we describe the case of a 30-year-old Mexican woman with newly diagnosed focal proliferative LN who also tested repeatedly positive for HBsAg by chemiluminescent microparticle immunoassay (CMIA). She had no clinical features of hepatitis and her liver function tests were within normal limits. Her abdominal ultrasound was also normal. While waiting for further results, she was started on lamivudine (100 mg daily). However, total HBV core antibody test was negative. Owing to the infrequency of this serological pattern, an in vitro polymerase chain reaction (PCR) assay was performed and HBV was not detected. Overall, we interpreted these results as a false-positive screening. Methylprednisolone pulse therapy was subsequently given (1 g daily for three doses) without hepatic repercussion, neither clinically nor biochemically. Conclusions Isolated HBsAg positivity may result from multiple causes, one of which is cross-reactivity. To the best of our knowledge, this is the first report of a false-positive reading using CMIA technique in an active lupus patient. It is reasonable to stress that lupus patients with a positive screening for HBV should undergo a confirmatory assay (such as genomic detection), since this diagnosis may have important therapeutic implications.",
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Delgado-García, G, Mandujano-Cruz, I, González-Padilla, K, Alarcón-Galván, G, Villarreal-Alarcón, MÁ & Galarza-Delgado, DÁ 2017, 'Isolated HBsAg positivity in a Mexican patient with newly diagnosed lupus nephritis', Egyptian Rheumatologist, pp. 49-52. https://doi.org/10.1016/j.ejr.2016.02.007

Isolated HBsAg positivity in a Mexican patient with newly diagnosed lupus nephritis. / Delgado-García, Guillermo; Mandujano-Cruz, Ilse; González-Padilla, Kiber; Alarcón-Galván, Gabriela; Villarreal-Alarcón, Miguel Ángel; Galarza-Delgado, Dionicio Ángel.

In: Egyptian Rheumatologist, 01.01.2017, p. 49-52.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Isolated HBsAg positivity in a Mexican patient with newly diagnosed lupus nephritis

AU - Delgado-García, Guillermo

AU - Mandujano-Cruz, Ilse

AU - González-Padilla, Kiber

AU - Alarcón-Galván, Gabriela

AU - Villarreal-Alarcón, Miguel Ángel

AU - Galarza-Delgado, Dionicio Ángel

PY - 2017/1/1

Y1 - 2017/1/1

N2 - © 2016 Egyptian Society for Joint Diseases and Arthritis Introduction Hepatitis B surface antigen (HBsAg) is usually regarded as a marker of hepatitis B virus (HBV) infection. The concurrence of lupus nephritis (LN) and HBsAg-positivity is a challenge for the clinician, since immunosuppressant use may be associated with an increase in viral replication and an exacerbation of liver disease. Case presentation Here, we describe the case of a 30-year-old Mexican woman with newly diagnosed focal proliferative LN who also tested repeatedly positive for HBsAg by chemiluminescent microparticle immunoassay (CMIA). She had no clinical features of hepatitis and her liver function tests were within normal limits. Her abdominal ultrasound was also normal. While waiting for further results, she was started on lamivudine (100 mg daily). However, total HBV core antibody test was negative. Owing to the infrequency of this serological pattern, an in vitro polymerase chain reaction (PCR) assay was performed and HBV was not detected. Overall, we interpreted these results as a false-positive screening. Methylprednisolone pulse therapy was subsequently given (1 g daily for three doses) without hepatic repercussion, neither clinically nor biochemically. Conclusions Isolated HBsAg positivity may result from multiple causes, one of which is cross-reactivity. To the best of our knowledge, this is the first report of a false-positive reading using CMIA technique in an active lupus patient. It is reasonable to stress that lupus patients with a positive screening for HBV should undergo a confirmatory assay (such as genomic detection), since this diagnosis may have important therapeutic implications.

AB - © 2016 Egyptian Society for Joint Diseases and Arthritis Introduction Hepatitis B surface antigen (HBsAg) is usually regarded as a marker of hepatitis B virus (HBV) infection. The concurrence of lupus nephritis (LN) and HBsAg-positivity is a challenge for the clinician, since immunosuppressant use may be associated with an increase in viral replication and an exacerbation of liver disease. Case presentation Here, we describe the case of a 30-year-old Mexican woman with newly diagnosed focal proliferative LN who also tested repeatedly positive for HBsAg by chemiluminescent microparticle immunoassay (CMIA). She had no clinical features of hepatitis and her liver function tests were within normal limits. Her abdominal ultrasound was also normal. While waiting for further results, she was started on lamivudine (100 mg daily). However, total HBV core antibody test was negative. Owing to the infrequency of this serological pattern, an in vitro polymerase chain reaction (PCR) assay was performed and HBV was not detected. Overall, we interpreted these results as a false-positive screening. Methylprednisolone pulse therapy was subsequently given (1 g daily for three doses) without hepatic repercussion, neither clinically nor biochemically. Conclusions Isolated HBsAg positivity may result from multiple causes, one of which is cross-reactivity. To the best of our knowledge, this is the first report of a false-positive reading using CMIA technique in an active lupus patient. It is reasonable to stress that lupus patients with a positive screening for HBV should undergo a confirmatory assay (such as genomic detection), since this diagnosis may have important therapeutic implications.

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DO - 10.1016/j.ejr.2016.02.007

M3 - Article

SP - 49

EP - 52

JO - Egyptian Rheumatologist

JF - Egyptian Rheumatologist

SN - 1110-1164

ER -

Delgado-García G, Mandujano-Cruz I, González-Padilla K, Alarcón-Galván G, Villarreal-Alarcón MÁ, Galarza-Delgado DÁ. Isolated HBsAg positivity in a Mexican patient with newly diagnosed lupus nephritis. Egyptian Rheumatologist. 2017 Jan 1;49-52. https://doi.org/10.1016/j.ejr.2016.02.007