ABSTRACT

Marked elevations in serum alpha fetoprotein (AFP) levels are highly suspicious for hepatocellular carcinoma and should prompt an extensive diagnosis. We report a case of chronic hepatitis B where episodes of marked elevations in serum AFP levels occurred, after viral breakthrough and acute exacerbation of hepatitis following development of lamivudine and adefovir resistance. The patient had a prompt improvement after adefovir and entacavir treatment, respectively.