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January 16, 1987

Fatal Reactivation of Chronic Hepatitis B

Author Affiliations

Athens Hospital for Infectious Diseases Greece

Athens Hospital for Infectious Diseases Greece

JAMA. 1987;257(3):315. doi:10.1001/jama.1987.03390030045012

To the Editor.—  In their recent JAMA case report, De Cock et al1 describe a fatal case of reactivation of chronic hepatitis B. IgM antibody to hepatitis B core antigen (IgM anti-HBc) became evident to a degree usually seen only in acute hepatitis B. Normal IgM found in human serum is predominantly pentameric, with a sedimentation coefficient of 19S; it is composed of five IgM subunits linked by a peptide J chain.2 Each subunit has a sedimentation coefficient of 7S to 8S. IgM anti-HBc with a sedimentation coefficient of 19S has been detected in acute hepatitis B3,4 and used to differentiate acute from chronic hepatitis B3 In contrast, the low molecular weight (sedimentation coefficient of 7S to 8S) IgM anti-HBc has been detected predominantly in patients with persistent HBV infection.3,4

Study.—  Separation of the 19S and 7S to 8S forms of serum IgM anti-HBc by rate-zonal