title: Extremely elevated alpha-fetoprotein due to acute exacerbation of chronic hepatitis B without malignancy: a case report.
abstract: BACKGROUND
  Alpha-fetoprotein is produced by a variety of tumors such as hepatocellular carcinoma, hepatoblastoma, and germ cell tumors of the ovary and testes. However, we present a case of significantly elevated serum alpha-fetoprotein without evidence of malignant disease in a patient who is a carrier of chronic hepatitis B.
  
  
  METHODS
  A 60-year-old Korean man presented with markedly increased alpha-fetoprotein (2350 ng/mL; normal <5 ng/mL). Various diagnostic evaluations, including computed tomography of the abdomen and thorax and ultrasonography of the abdomen and testes, showed liver cirrhosis and mild splenomegaly; however, no mass was detected in the liver, testes, or other organs scanned. The laboratory findings showed elevated liver function, positivity for hepatitis B e antigen, and a marked increase in hepatitis B virus deoxyribonucleic acid copy number (>7 × 105 IU/mL). Our patient was diagnosed with acute exacerbation of chronic hepatitis B, and we presumed that this condition might be related to extremely elevated alpha-fetoprotein. When our patient was treated with entecavir, the serum alpha-fetoprotein level immediately decreased, in parallel with the hepatitis B virus deoxyribonucleic acid copy number.
  
  
  CONCLUSIONS
  We report a rare case of extremely elevated alpha-fetoprotein due to acute exacerbation of chronic hepatitis B without any malignancy, and a decrease in this tumor marker simultaneous with a decrease in hepatitis B virus deoxyribonucleic acid copy number on entecavir treatment. This case report is important due to the rarity of the case; furthermore, it provides details of a diagnostic process for a variety of benign diseases and malignant tumors that should be considered in patients with elevated alpha-fetoprotein. Thus, we present a case report, along with a review, that will be helpful for diagnosis and treatment of patients with elevated alpha-fetoprotein.
authors.affiliation: Department of Internal Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea.
authors.forename: Young-Min
authors.initials: YM
authors.lastname: Yoon
authors.affiliation: Department of Internal Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea.
authors.forename: Da-Yeong
authors.initials: DY
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea.
authors.forename: Da-Young
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Department of Medicine, Graduate School of Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea.
authors.forename: Jun-Won
authors.initials: JW
authors.lastname: Seo
authors.affiliation: Department of Medicine, Graduate School of Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea.
authors.forename: Hyun-Jong
authors.initials: HJ
authors.lastname: Lim
authors.affiliation: Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea.
authors.forename: Hee-Jeong
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, Republic of Korea. sgpark@chosun.ac.kr.
authors.forename: Sang-Gon
authors.initials: SG
authors.lastname: Park
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000378:metabolism*; D004279:DNA, Viral / Q000097:blood; D003937:Diagnosis, Differential; D018450:Disease Progression; D006147:Guanine / Q000031:analogs & derivatives / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000378:metabolism*; D019562:Viral Load; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D000509:alpha-Fetoproteins; C413685:entecavir; D006147:Guanine
keywords: Hepatitis B; Hepatocellular carcinoma; Testicular cancer; Tumor markers; α-Fetoprotein