Acute Exacerbation of Chronic Hepatitis B: Clinical and Diagnostic Challenges in an Evolving Context
DOI:
https://doi.org/10.52556/2587-3873.2025.2(104).23Keywords:
hepatitis B, hepatocellular carcinoma, alphafetoprotein, viral replicationAbstract
Hepatitis B remains a major global public health problem, affecting approximately two billion individuals, of whom 250–292 million develop chronic infection. Although currently available antiviral therapies can effectively suppress viral replication, a definitive cure for chronic hepatitis B has not yet been identified. Furthermore, inhibition of viral replication reduces, but does not eliminate, the risk of hepatocellular carcinoma. We present the case of a 43-year-old patient, diagnosed with HBsAg positivity in 2016, who presented with marked asthenovegetative syndrome and a 23% body weight loss over the past seven months. The clinical picture was further characterized by persistent subfebrile temperature, pronounced asthenia, dyspeptic syndrome, gingivorrhagia, and diffuse pain. Physical examination revealed hepatosplenomegaly and cutaneous jaundice. Biochemical analyses demonstrated a pronounced cytolytic syndrome, hepatocellular insufficiency, and biliary excretory dysfunction, accompanied by a significant elevation of alpha-fetoprotein (1034.3 ng/ml). Superinfection with hepatitis D virus and other hepatotropic viruses was excluded, HBeAg was negative, and imaging investigations (CT and MRI) did not identify tumoral lesions. Etiotropic therapy with Tenofovir 300 mg/day was initiated, with good tolerance. At the seven-month follow-up, a significant reduction in viral load was observed, from 4.81×10^7 IU/ml to <10 IU/ml, alongside clinical and laboratory improvement and normalization of alpha-fetoprotein levels.
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