Hepatitis B Virus Reactivation Induce Acute-on-chronic Liver Failure Closely Followed By De Novo Hepatocarcinogenesis 4 Years After Curative Resection For Hepatocellular Carcinoma: Case Report

Background:It is now established that effective antiviral therapy with low serum hepatitis B virus (HBV) DNA level can decrease hepatocellular carcinoma (HCC) incidence. However, there is still uncertain thatHBV reactivation after HCC surgery can induce HCC recurrence. Further more, the anti-HBV treatment protocol after surgery is also unclear.Case presentation:A 66-year-old male with a long history of HBV infection was found HCC 5 months after lamivudine resistance mutation and the start of an additional adefovir. and then received a successful hepatectomy. Three years later, HBeAgseroconversion was achieved and nucleoside analogues were discontinued after 13 months of consolidation therapy. Soon after the withdrawn of antiviral treatment. HBV reactivated and acute-on-chronic liver failure (ACLF) occurred. Potent anti-HBV treatment with nucleoside analogues and foscarnet sodium injection effectively improved patient clinical condition. Three months after the clinical remission of ACLF, the patient was diagnosed as later HCC recurrence and received another hepatectomy. Tumor pathology was different between the later one and the initial one.Conclusion:Our findings suggest that HBV reactivation after HCC surgery may induce hepatitis flare and hepatocarcinogenesis, thus indefinite duration antiviral therapy and tight viral control should be performed in patients with chronic hepatitis B and HBV-related HCC.