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Causes of Acute Hepatitis in Patients With Chronic Hepatitis B Cause Clinical clues Spontaneous reactivation of hepatitis B Flare due to immunosuppression Seroconversion of HBeAg, reappearance of IgM anti-HBc Chemotherapy, antirejection therapy, corticosteroids, antitumor necrosis factor agents Induced by antiviral therapy Interferon (common), oral agents (rare) Superimposed infection with Exposure to HDV (usually due to illicit other viruses, especially HDV drug use), HAV, or HCV Other causes of acute hepatitis History of excessive use of alcohol, medications, or illegal drugs Abbreviations: anti-HBc, antibody to hepatitis B core antigen

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