title: A novel use of early radiation therapy in the treatment of hyperbilirubinemia in a patient with primary hepatic lymphoma and chronic hepatitis C.
abstract: Lymphomas arising in the liver are extremely rare. Here, we describe a case of Hepatitis C virus infection with primary hepatic lymphoma (PHL) presenting with hyperbilirubinemia. A 45-year-old African American male presented with abdominal pain, pruritus, and itching for two days. CT of abdomen and pelvis with contrast showed numerous masses in the liver. The liver biopsy was consistent with diffuse large B cell lymphoma (DLBCL). Conventional chemotherapy was avoided initially because of hyperbilirubinemia. Hence, radiation therapy was given initially to reduce his bilirubin levels and tumor size. The patient was able to complete six cycles of rituximab combined with cyclophosphamide, adriamycin, vincristine, and prednisone (R-CHOP) chemotherapy and achieved a complete response verified by positron emission tomography-computed tomography (PET-CT). PHL should be considered when there are numerous space occupying liver lesions seen on imaging. Hyperbilirubinemia may be a reason for delay in treatment for some of these patients. Hence, the role of radiation therapy prior to treatment with R-CHOP is an alternative to management for stage IV diffuse large B cell lymphoma.
authors.affiliation: Department of Internal Medicine, Howard University Hospital, 2041 Georgia Avenue, NW, Washington, DC 20060, USA.
authors.forename: Venkata S
authors.initials: VS
authors.lastname: Tammana
authors.affiliation: Department of Internal Medicine, Howard University Hospital, 2041 Georgia Avenue, NW, Washington, DC 20060, USA.
authors.forename: Rehana
authors.initials: R
authors.lastname: Begum
authors.affiliation: Department of Internal Medicine, Howard University Hospital, 2041 Georgia Avenue, NW, Washington, DC 20060, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Oneal
authors.affiliation: Department of Internal Medicine, Howard University Hospital, 2041 Georgia Avenue, NW, Washington, DC 20060, USA.
authors.forename: Hemamalini
authors.initials: H
authors.lastname: Karpurapu
authors.affiliation: Department of Internal Medicine, Howard University Hospital, 2041 Georgia Avenue, NW, Washington, DC 20060, USA.
authors.forename: Amruta
authors.identifier: 0000-0003-3511-799X
authors.initials: A
authors.lastname: Muley
authors.affiliation: Department of Internal Medicine, Howard University Hospital, 2041 Georgia Avenue, NW, Washington, DC 20060, USA.
authors.forename: Sri Lakshmi Hyndavi
authors.initials: SL
authors.lastname: Yeruva
authors.affiliation: Department of Radiation Oncology, Howard University Hospital, Washington, DC, USA.
authors.forename: Jacquelyn
authors.identifier: 0000-0003-3243-1748
authors.initials: J
authors.lastname: Dunmore-Griffith
authors.affiliation: Department of Internal Medicine, Howard University Hospital, 2041 Georgia Avenue, NW, Washington, DC 20060, USA.
authors.forename: Eyasu
authors.identifier: 0000-0002-8834-9949
authors.initials: E
authors.lastname: Mekonen
authors.affiliation: Department of Radiology, Howard University Hospital, Washington, DC, USA.
authors.forename: Nabhani
authors.initials: N
authors.lastname: Hasan