Disappearance of hepatitis B surface antigen during an unusual case of fulminant hepatitis B

A 30-year-old surgical resident was admitted to the hospital with symptoms of acute hepatitis; two days later he became comatose. Hepatitis B surface antigen had been detected in his serum two days prior to admission, but it was not detected at any time thereafter. Hepatitis B e antigen, antibody to hepatitis B core antigen, and antibody to hepatitis B surface antigen were detected using sensitive radioimmunoassays at admission. Titers of antibody to hepatitis B core antigen increased over the next five weeks. Clearance of hepatitis B e antigen and subsequent appearance of antibody to hepatitis B e antigen accompanied clinical improvement and recovery. This unusual case documents that hepatitis B surface antigen can become undetectable during the course of fulminant hepatitis B and indicates the importance of tests for other serologic markers of hepatitis B virus in the evaluation of hepatitis B surface antigen-negative fulminant hepatitis.