Zhang Yingqing, Sun Danfeng, Fang Yu, Feng Yan, Wu Yonglei, Shen Weifeng, Wu Wanxin, Gao Xixi, Sun Yuejiao, Ma Xiaolong, Gao Feng, Zhu Chaoping, Zhou Jiaqi, Gu Chao
Department of Respiratory Medicine, The First Hospital of Jiaxing (Affiliated Hospital of Jiaxing University), 1882 South Zhonghuan Road, Jiaxing, Zhejiang, 314000, China.
Zhejiang Key Laboratory of Digital Technology in Medical Diagnostics, Hangzhou, China.
BMC Infect Dis. 2025 May 2;25(1):645. doi: 10.1186/s12879-025-11049-4.
Hepatitis B virus (HBV) primarily affects the liver, but increasingly, it is recognized for its potential extrahepatic manifestations. This case highlights the importance of considering viral infections in the differential diagnosis of pulmonary nodules.
A 63-year-old man presented with a new mixed ground-glass nodule in the left lower lobe during a routine check-up. He had a history of liver resection for hepatocellular carcinoma, with results negative for hepatitis B virus surface antigen. The HBV viral load in the patient's serum was below the detection limit of quantitative PCR (qPCR). Immunohistological analysis of lung biopsy samples indicated chronic inflammation. However, after a course of intravenous antibiotics, the nodule increased in size, prompting further investigation. Therefore, lung biopsy tissue was subjected to metagenomic next-generation sequencing (mNGS), and HBV DNA was detected. The patient was diagnosed with secondary organizing pneumonia associated with HBV. Then he was treated with prednisone acetate and had remission.
This case underscores the potential for HBV to manifest as pulmonary complications, such as secondary organizing pneumonia. Therefore, in the stage of infectious diseases in patients with a history of hepatocellular carcinoma, HBV needs to be the focus of monitoring, so as to clarify the cause of diagnosis and treatment as soon as possible.
Not applicable.
乙型肝炎病毒（HBV）主要影响肝脏，但越来越多地，其潜在的肝外表现受到认可。本病例强调了在肺结节鉴别诊断中考虑病毒感染的重要性。
一名63岁男性在常规体检时发现左肺下叶有一个新的混合性磨玻璃结节。他有肝细胞癌肝切除病史，乙肝病毒表面抗原检测结果为阴性。患者血清中的HBV病毒载量低于定量PCR（qPCR）的检测限。肺活检样本的免疫组织学分析显示为慢性炎症。然而，经过一个疗程的静脉抗生素治疗后，结节增大，促使进一步检查。因此，对肺活检组织进行了宏基因组下一代测序（mNGS），检测到了HBV DNA。该患者被诊断为与HBV相关的继发性机化性肺炎。随后他接受了醋酸泼尼松治疗并缓解。
本病例强调了HBV表现为肺部并发症如继发性机化性肺炎的可能性。因此，在有肝细胞癌病史患者的感染性疾病阶段，HBV需要作为监测重点，以便尽快明确诊断和治疗原因。
不适用。
