Case Report on Hodgkin Lymphoma and Decompensated Chronic Liver Disease in a Patient With Chronic Hepatitis B Virus Infection: A Cause or an Effect?
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American Journal of Clinical Pathology
Chronic hepatitis B infection has been associated with the development of non-Hodgkin lymphoma (NHL), but its role in the etiology of Hodgkin lymphoma (HL) has been sparsely reported. This case report highlights the possibility of hepatitis B infection playing a major role in the etiology of Hodgkin disease and the complexity of managing HL in the presence of a decompensated liver disease. The chemotherapy in a patient with Hodgkin lymphoma and a liver disease requires dose adjustment and may reactivate a latent hepatitis infection. Our patient is a 23-year-old male who presented with symptomatic anemia, multiple cervical lymphadenopathies, abnormal liver function, and chronic HBV infection. A histologic diagnosis of nodular sclerosing HL was made following an excisional biopsy. There was a progressive liver disease with bleeding from the gums, generalized petechial and ecchymotic rashes, thrombocytopenia, prolonged PT (INR >5), deepening jaundice, and markedly elevated bilirubin and liver enzymes. He had blood component support, and tenofovir 300 mg daily was initiated. Liver functions improved, but liver enzymes were still four times the upper limit of normal when chemotherapy was commenced. He had dose-adjusted ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) chemotherapy with gradual improvement in the liver function and resolution of lymphadenopathy. It is unclear whether HBV infection is a nidus for Hodgkin lymphoma in this patient as it is for non-Hodgkin lymphoma or if the progression of Hodgkin disease leads to the flare of this. The outcome in this patient also buttresses the fact that, with appropriate dose adjustment, chemotherapy can be administered in the settings of decompensated liver disease.
Chronic hepatitis B , Infection , Liver diseases , Hepatitis infection , Research Subject Categories::MEDICINE
Bolarinwa, A.B., Adebayo, L.A., Otokiti, O. and Ogbenna, A.A. (2018). Case Report on Hodgkin Lymphoma and Decompensated Chronic Liver Disease in a Patient With Chronic Hepatitis B Virus Infection: A Cause or an Effect? American Journal of Clinical Pathology, 150(1), S110