A Case of Cholestatic Acute Hepatitis B Virus Infection with Severe Jaundice: Rapid Resolution with Corticosteroid Therapy

Authors

DOI:

https://doi.org/10.55544/jrasb.5.3.13

Keywords:

Acute hepatitis B, Intrahepatic cholestasis, Corticosteroid, Prednisolone, HBsAg seroconversion, Tenofovir alafenamide

Abstract

Cholestatic hepatitis is an uncommon but clinically significant manifestation of acute hepatitis B virus (HBV) infection, characterized by prolonged jaundice, impaired bile flow, and severe pruritus. The role of corticosteroids in HBV-related cholestasis remains controversial due to concerns about immunosuppression and viral reactivation. We report a 52-year-old hypertensive man with acute HBV infection who developed persistent cholestasis with a peak bilirubin of 32.1 mg/dL. Despite treatment with tenofovir alafenamide, ursodeoxycholic acid, and cholestyramine, no improvement was observed. Initiation of oral prednisolone (40 mg daily) led to rapid resolution of pruritus within one week and significant bilirubin reduction to 5.8 mg/dL in two weeks. Steroids were tapered over five weeks, with complete biochemical recovery. At 12-weeks follow-up, the patient achieved HBsAg seroconversion and undetectable HBV DNA. This case suggests corticosteroids may benefit selected patients with refractory cholestatic hepatitis B.

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References

[1] Shepard CW, Simard EP, Finelli L, Fiore AE, Bell BP. Hepatitis B virus infection: epidemiology and vaccination. Epidemiol Rev. 2006;28:112–125. doi: 10.1093/epirev/mxj009.

[2] World Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2023. Geneva: WHO; 2023. Available from: https://www.who.int/publications/i/item/9789240053779

[3] Hou J, Liu Z, Gu F. Epidemiology and prevention of hepatitis B virus infection. Int J Med Sci. 2005;2(1):50–57. doi: 10.7150/ijms.2.50.

[4] Liang TJ. Hepatitis B: the virus and disease. Hepatology. 2009;49(5 Suppl):S13–21. doi: 10.1002/hep.22881.

[5] Keeffe EB, Dieterich DT, Han SH, Jacobson IM, Martin P, Schiff ER, et al. A treatment algorithm for the management of chronic hepatitis B virus infection in the United States: 2008 update. Clin Gastroenterol Hepatol. 2008;6(12):1315–1341. doi: 10.1016/j.cgh.2008.08.021.

[6] Shivangi, Mishra MK, Gupta S, Razdan K, Sudan S, Sehgal S. Clinical diagnosis of viral hepatitis: current status and future strategies. Diagn Microbiol Infect Dis. 2024;108(3):116151. doi: 10.1016/j.diagmicrobio.2023.116151.

[7] Alebaji MB, Mehair AS, Shahrour OI, Elkhatib FA, Alkaabi EH, Alkuwaiti NS. Prolonged cholestasis following acute hepatitis A infection: case report and a review of literature. Cureus. 2023;15(5):e38511. doi: 10.7759/cureus.38511.

[8] European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370–398. doi: 10.1016/j.jhep.2017.03.021.

[9] Alter MJ. Epidemiology of hepatitis B in Europe and worldwide. J Hepatol. 2003;39 Suppl 1:S64–69. doi: 10.1016/s0168-8278(03)00141-7.

[10] Trauner M, Meier PJ, Boyer JL. Molecular pathogenesis of cholestasis. N Engl J Med. 1998;339(17):1217–1227. doi: 10.1056/NEJM199810223391707.

[11] Crocenzi FA, Mottino AD, Roma MG. Regulation of synthesis and trafficking of canalicular transporters and its alteration in acquired hepatocellular cholestasis. Experimental considerations for future therapeutics. Curr Med Chem. 2004;11(4):501–524. doi: 10.2174/0929867043455825.

[12] Ding C, Hong Y, Che Y, He T, Wang Y, Zhang S, Wu J, Xu W, Hou J, Hao H, Cao L. Bile acid restrained T cell activation explains cholestasis aggravated hepatitis B virus infection. FASEB J. 2022;36(9):e22468. doi: 10.1096/fj.202200234R.

[13] Lok AS, Liang RH, Chiu EK, Wong KL, Chan TK, Todd D. Reactivation of hepatitis B virus replication in patients receiving cytotoxic therapy: report of a prospective study. Gastroenterology. 1991;100(1):182–188. doi: 10.1016/0016-5085(91)90599-g.

[14] Terrault NA, Lok ASF, McMahon BJ, Chang KM, Hwang JP, Jonas MM, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560–1599. doi: 10.1002/hep.29800.

[15] Tanaka H, Tsukuma H, Yamano H, Oshima A, Shibata H. Prednisolone therapy for acute cholestatic hepatitis B. J Gastroenterol Hepatol. 1995;10(5):581–584. doi: 10.1111/j.1440-1746.1995.tb01355.x.

[16] Coppola N, Tonziello G, Colombatto P, Pisaturo M, Messina V, Moriconi F, et al. Lamivudine-resistant HBV strain rtM204V in acute hepatitis B. J Infect. 2013;67(4):322–329. doi: 10.1016/j.jinf.2013.04.014.

[17] Paumgartner G, Beuers U. Ursodeoxycholic acid in cholestatic liver disease: mechanisms of action and therapeutic use revisited. Hepatology. 2002;36(3):525–531. doi: 10.1053/jhep.2002.36088.

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Published

2026-06-30

How to Cite

Bhuiyan, N. N. M., Ghosh, D. J., & Ghosh, J. (2026). A Case of Cholestatic Acute Hepatitis B Virus Infection with Severe Jaundice: Rapid Resolution with Corticosteroid Therapy. Journal for Research in Applied Sciences and Biotechnology, 5(3), 99–103. https://doi.org/10.55544/jrasb.5.3.13

Issue

Vol. 5 No. 3 (2026): June Issue

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Copyright (c) 2026 Dr. Nafsin Nur Morshed Bhuiyan, Dr. Jhumur Ghosh, Jaya Ghosh

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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