Poster Session : PS 1525 ; Rheumatology : Reactivation of Chronic Hepatitis B in Dermatomyositis Patient

Dermatomyositis (DM) is an idiopathic in. ammatory with typical cutaneous manifestations. Opportunistic infection is increased due to immunossuppresive therapy like steroid and methotraxate for DM. Association between DM and reactivation of chronic hepatitis B has rarely been proposed. A 81-year-old woman with chronic hepatitis B was admitted to our hospital with both shoulder pain, erythematous bullaes on the both arms and swollen edematous plaques on the trunk, neck, both arms and thighs. Laboratory test revealed; CRP 6.094 mg/dL, AST/ALT 144/35 IU/L, total bilirubin 0.56 mg/dL, HBsAg positive, HBsAb negative, HBcAb positive, HBeAg negative, HBeAb positive, and HBV DNA copy <116 copies/ml. In the NCV and EMG, they revealed generalized active myopathy. Muscle biopsy finding was CD3+ lymphocyte in. ltration, atrophy, degeneration, and regeneration of muscle cells. The patient was diagnosed dermatomyositis, and treated with high-dose steroid and methotrexate. Four months later, she was re-admitted with fever for 4 days. She had sepsis with urinary tract infection and treated with antibiotics. After treatment, fever was improved. A few days later, fever and jaundice were developed. Serum test was AST/ALT 223/161 IU/L, total bilirubin 5.64 mg/dL and HBV DNA copy 912,089,151 copies/ml. We diagnosed reactivation of chronic hepatitis B, and used tenofovir disoproxil. But the patient was expired due to hepatic failure with fulminant hepatitis. Association between DM with immunosuppresive treatment and reactivation of chronic hepatitis B has rarely been proposed, and yet never been in Korea. It is recommended that HBsAg-positive candidates for immunosuppressive therapy should be tested for HBV DNA levels and receive pre-emptive antiviral agents during therapy. Because the medical assurance does not admit that treatment in Korea, it is dif. cult to be applied in practice. The authors describe this case because it is rare case in Korea and necessary for discussion of this issue.