Deadly Face Of Vertical And Familial Transmission In HBV

Introduction: Hepatitis B virus (HBV) impacts large number of populations worldwide and has both hepatic and extrahepatic manifestations. It can present as acute hepatitis, chronic hepatitis, cirrhosis and hepatocellular carcinoma (HCC). The available data provide evidence that HBV infection is associated with the risk of developing HCC with or without an underlying liver cirrhosis, due to various direct and indirect mechanisms promoting hepatocarcinogenesis. Case Report: We report a fourty two-year-old male, not a known case of any chronic illness, was totally asymptomatic and his brother recently died due to hepatitis B related chronic liver disease and hepatocellular carcinoma. Thus, family screening was advised. They were total six brother & sister who were living, along with their mother and father. Out of these eight all six brother and sisters & mother were found to be hepatitis B positive and only father was hepatitis B negative who was given whole course of HBV vaccination. On evaluation, our above patient was also having hepatitis B related chronic liver disease with H.C.C. He was out of liver transplant criterion, hence was started on antiviral and sorafenib treatment. One more brother was having significant fibrosis with high viral load and raised transaminases, thus was started on antiviral treatment. The rest of family members were inactive carriers but in view of strong family history of HBV related HCC were started on antiviral treatment and regular follow up. Moreover, all their spouses and children were screened for viral screen and none was found to be HbsAg positive and everyone was given full course of HBV vaccine. Conclusion: Hepatitis B has many presentations varying from inactive carrier stage in majority to cirrhosis and H.C.C. The family screening is must, as it can help in timely detection of not only HBV infection but also its complication like H.C.C. The non-infected family members should all be mandatory vaccinated with HBV. Keywords: Chronic hepatitis B, Hepatocellular carcinoma, vertical transmission, Ascites, Portal Vein thrombosis.