AI Summary & Key Takeaways
AI InsightSince the patient had a rapid viral and biochemical response to entecavir, the drug was continued under close follow-up and there was no further progression of the gynecomastia.
📌 3 Key Takeaways
Abstract
Hepatitis B is an important health problem all over the world as well as in our country. Entecavir is a nucleoside analog used in the treatment of chronic hepatitis B. We present a case of a 55-year-old male patient who developed unilateral gynecomastia while under treatment with entecavir. Physical examination was unremarkable except for minimal hepatomegaly. Laboratory examination revealed: HbsAg: positive, HBeAg: negative, anti-HBe: positive, HBV DNA: 800,000 copies/ml, total antiHDV: negative, and alanine aminotransferase: 105 U/L (normal range: 0-41). The treatment was started with pegylated interferon. During the follow-up, transaminases did not regress and HBV DNA was found to still be highly positive at the sixth month evaluation. Pegylated interferon treatment was stopped and entecavir was started at a dose of 0.5 mg/day. Six months after the initiation of entecavir treatment, the patient presented with a painful swelling in the right breast. On physical examination, there was painful gynecomastia on the right side, which was confirmed with mammography and ultrasound of the breast tissue. The patient was not taking any drug that may have caused gynecomastia. Hormonal status of the patient was normal. Laboratory values were normal. We considered that this unilateral gynecomastia might be an adverse effect of entecavir. Since the patient had a rapid viral and biochemical response to entecavir, the drug was continued under close follow-up and there was no further progression of the gynecomastia.
Özet
Hepatit B tüm dünyada olduğu gibi ülkemizde de önemli bir sağlık sorunudur. Entekavir kronik B hepatiti tedavisinde kullanılan bir nükleosid analoğudur. Biz entekavir tedavisi altında gelişen tek taraflı jinekomasti olgusunu sunacağız. 55 yaşında erkek hasta. Fizik muayenesinde minimal hepatomegali dışında bir özellik yok. Laboratuvar incelemesinde HbsAg pozitif, HBe-Ag negatif, Anti-HBe pozitif, HBVDNA: 800.000 kopya/mL, Anti-HDV total negatif, alanine aminotransferase 105 U/l (normal aralık: 0-41) bulundu. Pegile interferon tedavisi başlandı. Takiplerinde transaminaz değerleri azalmadı ve tedavinin 6. ayında bakılan HBVDNA seviyesi aynı düzeyde bulundu. İnterferon tedavisi kesildi ve entecavir 0.5 mg/gün başlandı. Entekavir tedavisi başlandıktan altı ay sonra hastanın sağ memesinde ağrılı şişlik başladı. Fizik muayenede saptanan sağ taraftaki ağrılı jinekomasti, mamografi ve ultrason ile doğrulandı. Hasta jinekomastiye neden olabilecek ilaç veya toksik bir madde kullanmıyordu. Hormon profili normaldi. Laboratuvar değerlerinde bir özellik yoktu. Biz bu tek taraşı gelişen jinekomastinin entekavire bağlı bir yan etki olduğunu düşündük. Hastada entekavir ile hızlı bir biyokimyasal ve viral cevap alındı. Bu nedenle tedavi kesilmeden hasta takip edildi ve jinekomastide herhangi bir ilerleme gözlenmedi.