An unusual case of HBV reactivation in a patient with cholangitis and choledocho-lithiasis undergone to ERCP. A case report

Introduction: In the landscape of presentation of HBV infection, it is possible to identify patients with Hepatitis B "e" Antigenpositive chronic hepatitis B infection without liver disease (previously called "asymptomatic chronic carrier"), and in the natural history of this condition an Hepatitis B Virus reactivation is possible. In literature it has been shown that reactivation often occurs during conditions of immunosuppression or chemotherapy, although in recent years case reports of Hepatitis B Virus reactivation are emerging in chronic coinfected patients after therapy with Direct Acting Antivirals. Materials and methods: We describe a clinical case of Hepatitis B Virus HBV reactivation not ordinarily secondary to immunosuppression or chemotherapy, but realistically secondary to choledocholithiasis. It has been supposed an atypical reactivation of HBV, and therefore an antiviral treatment with entecavir has been promptly initiated. Results: At 24 weeks and one year after the antiviral treatment, the patient showed a normalization of all liver function tests and an undetectable HBV DNA with Polymerase Chain Reaction test. Conclusion: In case of liver dysfunction in a patient with an history of HBV infection, we suggest to firstly suspect and test a viral reactivation and then, if the reactivation is confirmed, to start the antiviral therapy as early as possible. It would be also desirable to evaluate the extension of the pre-treatment protocols with 3rd generation Nucleos-(t)ide analogues even in the case of important septic episodes, major surgery and invasive procedures.