Hiura Masaaki, Onizuka Ryo, Narita Ryoichi, Abe Shintaro, Tabaru Akinari, Harada Masaru
Third Department of Internal Medicine, University of Occupational and Environmental Health, Japan School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
Clin J Gastroenterol. 2010 Oct;3(5):254-8. doi: 10.1007/s12328-010-0171-z. Epub 2010 Sep 16.
A 59-year-old male patient underwent surgical treatment for non-Hodgkin's lymphoma of the right scrotum in October 2007. He received a total of 4 courses of two different adjuvant chemotherapy regimens including rituximab from January to April 2008. In June 2008 he was hospitalized due to severe liver dysfunction with an alanine aminotransferase of 2039 IU/l and a prothrombin time of 23.3%. He was diagnosed with acute hepatitis C by the detection of hepatitis C virus (HCV) RNA and negative anti-HCV antibody, and his hepatic function improved with bed rest during hospitalization; however, the production of anti-HCV antibodies was not detected until January 2009. Severe liver dysfunction is uncommon among patients with acute hepatitis C, and the long window (8 months) between HCV infection and the development of anti-HCV antibodies observed in the present case may have been due, at least in part, to a B cell disorder caused by rituximab therapy. In addition to the well-known risk of reactivation of hepatitis B virus infection in patients undergoing chemotherapy, physicians should be aware of the potential effects of chemotherapy on the clinical course of HCV infection.
一名59岁男性患者于2007年10月接受了右侧阴囊非霍奇金淋巴瘤的手术治疗。2008年1月至4月，他共接受了4个疗程的两种不同的辅助化疗方案，包括利妥昔单抗。2008年6月，他因严重肝功能不全住院，丙氨酸转氨酶为2039 IU/l，凝血酶原时间为23.3%。通过检测丙型肝炎病毒（HCV）RNA且抗HCV抗体阴性，他被诊断为急性丙型肝炎，住院期间卧床休息后肝功能有所改善；然而，直到2009年1月才检测到抗HCV抗体的产生。严重肝功能不全在急性丙型肝炎患者中并不常见，本病例中观察到的HCV感染与抗HCV抗体出现之间的较长窗口期（8个月）可能至少部分归因于利妥昔单抗治疗引起的B细胞紊乱。除了化疗患者中众所周知的乙肝病毒感染再激活风险外，医生还应意识到化疗对HCV感染临床病程的潜在影响。
