Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report

Area of Science:

• Hepatology
• Gastroenterology
• Virology

Background:

• Chronic hepatitis B (CHB) is a common cause of liver iron overload, but severe secondary hemochromatosis (SH) is rare.
• Patients with CHB may experience ongoing liver inflammation and viral replication despite treatment.

Observation:

• A 48-year-old man with vertically transmitted CHB presented with skin darkening and biochemical/imaging evidence of hemochromatosis after 21 years of nonstandard antiviral therapy.
• Liver biopsy confirmed severe iron overload, and genetic testing excluded hereditary hemochromatosis.

Findings:

• The patient was diagnosed with SH and treated with phlebotomy and an iron-chelating agent, resulting in normalized liver function and skin depigmentation within 12 weeks.
• Following treatment, the patient lost hepatitis B surface antigen (HBsAg) and was diagnosed with occult hepatitis B infection, with undetectable HBV DNA after tenofovir therapy.
• Hemochromatosis improvement correlated with enhanced hepatitis B virus (HBV) control and may have contributed to HBsAg seroclearance.

Implications:

• This case highlights the potential link between severe iron overload and CHB, suggesting that managing hemochromatosis can impact HBV markers.
• Effective treatment of secondary hemochromatosis may lead to improved outcomes in chronic hepatitis B patients, including the potential for HBsAg loss.
• Occult hepatitis B infection requires careful monitoring and management, especially in patients with coexisting conditions like hemochromatosis.