De novo hepatitis B in a patient with negative hepatitis B core antibody and high normal range hepatitis B surface antibody treated with R-CHOP therapy for Diffuse large B-cell lymphoma

Abstract

We present a case of a female patient with diffuse large B-cell lymphoma treated with R-CHOP therapy. Initially, hepatitis B virus (HBV) tests were negative for HB surface (HBs) antigens and HB core antibodies. HBs antibodies were negative (9.5 mIU/mL, cut off 10.0 mIU/mL). Therefore, HBV reactivation monitoring was not performed. After 13 months, biochemical tests showed elevated transaminase levels, and HBs antigens were positive. Because the HBs antibody titer at the initiation of R-CHOP therapy was in the high normal range, the patient was diagnosed with de novo hepatitis B with resolved HBV infection. The reference value of HBs antibodies for resolved HBV infection remains unknown. Considering that HBs antibody titer of 10 mIU/mL is the minimum value for protection against HBV infection, focusing on the titers of HBV markers is necessary if therapy with a high risk of HBV reactivation is initiated.