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• W2977771753 abstract "Purpose: 54-year-old Caucasian man had nausea, vomiting and right upper quadrant pain for 2 weeks. His significant past history includes hepatitis B and C, umbilical herniorhhapy and bilateral knee arthroscopies. He takes insulin, lisinopril, metaprolol, neurontin and prilosec. He is an ex-smoker, denies alcohol intake and used marijuana remotely in the past. Methods: On examination pertinent positive findings include morbid obesity, body full of tattoos, BP 154/86, bilateral pedal oedema, distended abdomen with Murphy's sign positive. His significant labs include total bilirubin 6.4, direct bilirubin 4.9, alkaline phosphatase 196, ALT 70, AST 98, albumin 2.8, Hb 10 and chest x-ray showed multiple bilateral diffuse non-calcified pulmonary nodules. Gall bladder echo revealed multiple gallstones. HIDA scan findings were consistent with chronic cholecystitis. CAT scan of chest confirmed bilateral diffuse pulmonary nodules and of abdomen revealed multiple enlarged retro crural, perihepatic, pericaval and cardiophrenic lymphnodes with significant ascites. Ascitic fluid analysis revealed portal hypertension related ascites caused by porta hepatis lymphadenopathy rather than grade 2 liver fibrosis on metavir scores, and negative for infection and malignancy. The day following paracentesis, he was aggressive and confused. His labs were Hb 9, ammonia 320, BUN 33, creatinine 1.6 (baseline 0.5) and INR 1.7. EGD showed non-bleeding distal grade 1 oesophageal varices. Hepatic encephalopathy and hepatorenal syndrome was diagnosed and treated accordingly with good improvement. Hepatitis serology revealed positive HCV IgG antibody, genotype 1b, HCV RNA level of 4 million IU/mL and immune to hepatitis B. CAT scan guided perihepatic lympnode biopsy revealed B cell lymphoma. Results: Diagnosing his hepatitis C associated B cell lymphoma was really a challenge as such lymphoma presenting as bilateral diffuse pulmonary nodules and multiple enlarged retro crural, perihepatic, pericaval and cardiophrenic lymphnodes is a rare entity. He was started on antiviral therapy (pegylated interferon and ribavarin) while waiting for liver transplantation. Conclusion: This case report illustrates the challenge of diagnosing a lymphoproliferative disorder in a patient with unexplained anaemia and lymphadenopathy. According to AASLD guidelines, antiviral therapy for hepatitis C with decompensated cirrhosis can be individualized based on other co-morbidities. The role of combination therapy for HCV associated B cell lymphoma has not been well studied to know the success rates, as only limited data are available regarding the effects of antiviral therapy on rearranged B cell clones. This is one of the research areas that need to be explored in future." @default.
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• W2977771753 date "2008-09-01" @default.
• W2977771753 modified "2023-09-25" @default.
• W2977771753 title "Unexplained Anemia, Pulmonary Nodules and Lymphadenopathy in a Cirrhotic Patient" @default.
• W2977771753 doi "https://doi.org/10.14309/00000434-200809001-00598" @default.
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