Prolongation of the prodrome to acute hepatitis B infection by corticosteroids

A 56-year-old woman had rash, arthralgia, and lymphadenopathy. Prednisone therapy caused the symptoms to abate but not disappear. Medication was continued for almost eight weeks, during which time the symptoms persisted. While the patient was receiving therapy, serologic evidence of hepatitis B infection was noted. When prednisone therapy was stopped, the patient rapidly passed from the prodrome to typical, acute, icteric hepatitis. Prednisone may have suppressed normal immunologic responses to the hepatitis virus, resulting in persistence of the serum sickness-like state. Corticosteroids are not indicated in the treatment of the prodrome to hepatitis B infection.