Ankylosing Spondilitis in a Patient with Hepatitis Reactivation Treated with Anti-tumor Necrosis Factor Alpha: A Case Report

Abstract

Ankylosing spondylitis (AS), a type of spondyloarthropathy, is an autoimmune disease characterized by inflammation that mostly affects soft tissues, such as the axial skeleton, sacroiliac joint, tendons, and ligaments. The aims of AS treatment are to restore spinal flexibility, improve posture, relieve symptoms, prevent limitations in range of motion, and decrease complications. In medical treatment steps, patients with high disease activity despite treatment with non-steroidal anti-inflammatory drugs are recommended to be treated with biologic agents, including anti-tumor necrosis factor-alpha and interleukin-17 inhibitors. The risk of serious infection should be considered in patients treated with biologic agents. Anti- tumor necrosis factor (TNF)- agents administered without appropriate antiviral prophylaxis in patients with chronic hepatitis-B virus infection have been shown to induce viral reactivation. Therefore, they should be used in combination with antiviral therapy. However, rare cases of hepatitis reactivation although antiviral prophylaxis are reported in the literature. We aimed to present a case of hepatitis-B reactivation despite the use of a prophylactic antiviral drug with an anti-TNF- agent.

Keywords

• hepatitis-b infection
• spondyloarthropathy
• ankylosing spondylitis
• hepatitis reactivation
• anti-tumor necrosis factor-alpha