title: Acute hepatic injury after discontinuation of chemotherapy in a patient with non-Hodgkin's lymphoma and chronic hepatitis B virus infection.
abstract: We describe a HBsAg-positive patient with non-Hodgkin's lymphoma who underwent aggressive chemotherapy. After discontinuation of chemotherapy, he developed jaundice due to a reactivation of the hepatitis B. Serum HBeAg and HBV DNA turned positive, indicating active virus replication. Abdominal CT-scan showed a large solitary tumour mass in the liver and the serum alpha-fetoprotein level was extremely high, suggesting HBV-related hepatoma. After discontinuation of chemotherapy, the patient died of non-Hodgkin's lymphoma and hepatocellular carcinoma. Throughout treatment of HBsAg-positive patients with cytotoxic or immunosuppressive therapy, careful monitoring of serum aminotransferase levels and HBV DNA is essential. Aggressive chemotherapy may have to be discontinued or changed to a milder regimen if hepatitis occurs.
authors.affiliation: Department of Internal Medicine, Bronovo Hospital, The Hague, Netherlands.
authors.forename: J B
authors.initials: JB
authors.lastname: Haanen
authors.forename: R
authors.initials: R
authors.lastname: Bieger
authors.forename: J W
authors.initials: JW
authors.lastname: van't Wout
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis; D003520:Cyclophosphamide / Q000008:administration & dosage; D006509:Hepatitis B / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D016609:Neoplasms, Second Primary; D011241:Prednisone / Q000008:administration & dosage; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D003520:Cyclophosphamide; D011241:Prednisone