• Fenfang Wang, Qianchun Zhang, Ju Zhang, Penghui Yang, Fei Pan, Xuefang Ren, Hang Yuan, and Zhongbao Chang.
• Department of Clinical Immunology, Nanjing Kingmed Clinical Laboratory, Nanjing, Jiangsu, China.
• Medicine (Baltimore). 2025 Jan 10; 104 (2): e41197e41197.

RationaleMass vaccination, low cost of immunoglobulins, and new drugs led to the emergence of new, unusual patterns of hepatitis B serum markers. This study reported a rare case of hepatitis B with all 5 positive serum markers, including HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb.Patient ConcernsA 30-year-old female patient was admitted due to abnormal liver function. The 5 serum markers were all positive (+), including HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb. After antiviral therapy, she was discharged with normal liver function and decreased hepatitis B virus-DNA levels, but all 5 serum markers were still positive. Regular follow-up was conducted every 3 months.DiagnosesAbnormal liver function.InterventionsThe patient received antiviral treatment and liver protection therapy using entecavir dispersive tablet 0.5 mg po qd and glycyrrhizate diamine enteric capsule 150 mg po tid.OutcomesThe patient's liver function was normal, hepatitis B virus-DNA continued to decline, and HBeAb turned negative at 6 months. After 9 and 12 months of follow-up, the results of hepatitis B markers in the patient were stable in HBsAg positive (+), HBeAb positive (+), and HBcAb positive (+).LessonsThe rare pattern of all 5 positive hepatitis B markers may occur in patients with chronic hepatitis B. Improvements can be achieved using first-line drugs and conventional treatment. Nevertheless, more attention should be paid to the patient's condition.Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.

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