Supplementary Material for: A fatal outcome after cessation of nucleotide analogue therapy in a patient with chronic hepatitis B

Introduction: Emerging evidence suggest that long-term nucleotide analogue (NA) therapy can be ceased in a selective group of chronic hepatitis B (CHB). This is being gradually implemented in clinical practice.
Case presentation: A 68-year-old man known with a chronic HBeAg-positive hepatitis B infection without signs of advanced liver fibrosis or cirrhosis, was admitted with acute liver failure. Two months prior to his admission, he ceased his NA therapy. During the admission, NA therapy was re-started, but the liver function worsened. The patient was put on the high-urgency liver transplantation waiting list and the next day he was successfully transplanted. However, the patient died seventeen days later due to haemorrhagic shock that resulted from intra-abdominal bleeding and acute pancreatitis.
Conclusion: Current guidelines suggest that NA therapy can be discontinued in a selective group of CHB patients. However, these guidelines suggest different stopping- and follow-up criteria. This case illustrates that NA withdrawal is not without risks and that these differences in recommendations may lead to inadequate management and eventually fatal outcome.