Cassidy Alexandre, MD, Asra Batool, MD
Albany Medical Center, Albany, NY
Reactivation of hepatitis B (HBV) is typically triggered by immunosuppressive therapy of cancer, autoimmune disease, or organ transplantation. Here we report a rare case of spontaneous reactivation of hepatitis B in a patient newly diagnosed with adult T-cell lymphoma/leukemia without any exposure to immunosuppressive therapy of cancer.
A 34-year-old African American male was transferred from an outside institution for further management of probable T-cell lymphoma/leukemia as severe lymphocytosis was initially noted. Presenting symptoms included weakness and fatigue as well as bilateral conjunctival redness. His abdomen was mildly distended, and hepatomegaly was noted. Of interest, he was found to have elevated liver function tests (LFTs) and hepatitis panel showed acute hepatitis B with bloodwork significant for positive hepatitis B surface antigen, negative hepatitis B surface antibody, negative hepatitis B core IgM, positive hepatitis B core antibody and hepatitis B viral load of 16,954. Labs for hepatitis A and C were negative. He denied any known risk factors for hepatitis. Abdominal imaging showed peripancreatic concern of mass or swelling, mild hepatomegaly, splenomegaly and marked lymphadenopathy in the celiac, perigastric, pancreatic and aortocaval regions. Of note, he has not been on any immunosuppressive therapy or steroids prior to hospital admission. On hospitalization day #5, he was started on tenofovir and subsequently liver function tests continued to improve. He was also started on IV Solu-Medrol 1 g per day for 3 days with IV hydration and oral allopurinol. He continued to undergo diagnostic work-up as per hematology and Oncology prior to starting chemotherapy. On the day of discharge (day #17), remarkable improvement in his LFTs was noted. He was seen in GI clinic about 3 weeks later and his hepatitis B viral load was 760 and ALT was within normal limits.
HBV reactivation is common following chemotherapy and is associated with a high mortality, however spontaneous HBV reactivation in the absence of cancer chemotherapy or transplantation is a rare clinical entity. Adult T-cell lymphoma/leukemia likely contributes to immune suppression or alteration in immune function causing spontaneous HBV reactivation. This case highlights the importance of screening all patients who are to undergo cancer chemotherapy, marked immunosuppressive treatments or solid organ or bone marrow transplantation for evidence of ongoing or previous hepatitis B.
Citation: Cassidy Alexandre, MD, Asra Batool, MD. P1665 - AN UNUSUAL CASE OF SPONTANEOUS REACTIVATION OF HEPATITIS B IN ADULT T-CELL LYMPHOMA/LEUKEMIA. Program No. P1665. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.