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Case Reports
. 2025 Sep 8;56(5):577-581.
doi: 10.1093/labmed/lmaf003.

Longstanding, undiagnosed, highly replicative hepatitis B virus reactivation in the presence of high levels of anti-HBs antibodies

Mahdi Ouafi  1 , Alexandre Réguème  1 , Stéphane Chevaliez  2 , Emmanuel Faure  3 , Aurélie Guigon  1 , Magali Bouvier-Alias  2 , Valérie Canva  4 , Didier Hober  1 , Laurence Bocket  1 , Enagnon Kazali Alidjinou  1
Affiliations
Case Reports

Longstanding, undiagnosed, highly replicative hepatitis B virus reactivation in the presence of high levels of anti-HBs antibodies

Mahdi Ouafi et al. Lab Med. .

Abstract

Introduction: Kidney transplant recipients are among the populations at risk for Hepatitis B Virus (HBV) reactivation, and close monitoring is needed for its early detection.

Methods: We describe a case of HBV reactivation in a patient who underwent kidney transplantation more than 30 years ago, with a known serological profile of past HBV infection.

Results: Reactivation occurred as a highly replicative infection that went undiagnosed for 7 years due to negative results for HB surface antigen (HBsAg) and high levels of anti-HBs antibodies. Viral genome sequencing showed a high number of mutations in the major hydrophilic region of HBsAg that could explain such a profile.

Discussion: This case highlights the usefulness of frequent and systematic HBV viral load testing in patients at risk of reactivation, with anti-hepatitis B core antibodies, regardless of HBsAg detection, aminotransferases, and anti-HBs antibody levels.

Keywords: hepatitis B surface antigen; hepatitis B virus; mutations; reactivation; viral load.

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