Volume 32, Number 2—February 2026
Research Letter
Acute Severe Hepatitis B Virus Infection in Previously Vaccinated Patient during Acalabrutinib Treatment
Lukasz Rojek
, Tomasz Wnuk-Lipinski, Iwona Marek, Hubert Grabowski, and Krystian Adrych
, Tomasz Wnuk-Lipinski, Iwona Marek, Hubert Grabowski, and Krystian Adrych
Table 1
Blood test results from a case of severe HBV infection in previously vaccinated patient during acalabrutinib treatment*
| Biochemical parameter | Before HBV infection | Day of hospitalization |
||||||
|---|---|---|---|---|---|---|---|---|
| −13 | −3 | 0 | 1 | 2 | 3 | 4 | ||
| Total bilirubin, mg/dL | 0.84 | 2.19 | 23.04 | 43.02 | 32.17 | 33.76 | 33.89 | 35.66 |
| Alanine aminotransferase, U/L | 27 | NA | 2,688 | 3,780 | 2,603 | 2,024 | 1,340 | 875 |
| Aspartate aminotransferase, U/L | 29 | 945 | 3,877 | 4,400 | 3,146 | 2,384 | 1,058 | NA |
| Alkaline phosphatase, U/L | NA | NA | 212 | 211 | 164 | NA | 147 | NA |
| Gamma-glutamyltransferase, U/L |
NA |
NA |
421 |
233 |
171 |
NA |
107 |
NA |
| Ammonia, µmol/L | NA | NA | NA | 221 | NA | NA | 92 | NA |
| International normalized ratio | NA | NA | 2.89 | >6.12 | >6.12 | >6.12 | >8.6 | >8.6 |
| Creatinine, mg/dL |
0.79 |
0.66 |
0.69 |
1.63 |
2.33 |
3.13 |
3.94 |
4.43 |
| Sodium, mmol/L | 141 | 136 | 136 | 129 | 126 | 121 | 118 | 117 |
| Potassium, mmol/L |
4.3 |
4.5 |
4.5 |
6.4 |
5.9 |
5.1 |
4.6 |
4.6 |
| Hemoglobin, g/dL | 13.7 | 13.9 | NA | 14.3 | 11.8 | 11.1 | 9.9 | 9.5 |
| Erythrocytes, × 1012 cells/L | 4.02 | 4.13 | NA | 4.4 | 3.55 | 3.38 | 3.0 | 2.9 |
| Platelets, × 109/L | 207 | 150 | NA | 245 | 159 | 135 | 89 | 80 |
| Total leukocytes, × 109 cells/L |
8.01 |
6.1 |
NA |
8.33 |
7.43 |
6.24 |
5.27 |
5.04 |
| C-reactive protein, mg/L |
1.12 |
NA |
21.17 |
14.85 |
9.38 |
NA |
4.08 |
NA |
| Procalcitonin, ng/mL | NA | NA | NA | NA | 0.84 | 0.81 | NA | 0.61 |
*HBV, hepatitis B virus; NA, not available.
Page created: January 29, 2026
Page updated: February 19, 2026
Page reviewed: February 19, 2026
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