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Title: Liver failure from delayed hepatitis B reactivation in anti-HBc-positive patient following rituximab for B-cell lymphoma.
Austin Authors: Borojevic, Branko;Chauhan, Ayushi;Patterson, Scott J 
Affiliation: Gastroenterology and Hepatology
General Medicine
General Medicine, Eastern Health, Box Hill, Victoria, Australia
Issue Date: 9-Jul-2021
Date: 2021-07-09
Publication information: BMJ Case Reports 2021; 14(7): e243526
Abstract: A 93-year-old man was admitted with 1 week of frank jaundice and abdominal pain. His medical history included diffuse large B-cell lymphoma treated with rituximab and cyclophosphamide, hydroxydaunomycin, oncovin and prednisolone (R-CHOP) chemotherapy 10 months prior. His investigations revealed marked hyperbilirubinemia with a total bilirubin of 355 μmol/L, along with a 17-fold elevation in alanine transaminase and impaired hepatic synthetic function. He tested hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (HBsAb) negative, hepatitis B core antibody (HBcAb) positive and had elevated hepatitis B virus DNA level at 13 691 IU/L. This was in the setting of radiological evidence of suspected cirrhosis. He was later found to have tested positive for HBcAb and negative for HBsAg and HBsAb prior to chemotherapy, but had not received antiviral prophylaxis. He was diagnosed with fulminant hepatitis secondary to delayed hepatitis B reactivation in the setting of rituximab. Hepatitis B reactivation and the role of screening and antiviral prophylaxis in isolated HBcAb-positive patients is reviewed.
DOI: 10.1136/bcr-2021-243526
Journal: BMJ Case Reports
PubMed URL: 34244190
Type: Journal Article
Subjects: chemotherapy
haematology (incl blood transfusion)
hepatitis B
liver disease
Appears in Collections:Journal articles

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