Practice corner: should we screen all patients starting chemotherapy for chronic hepatitis B virus infection?

A 64-year old Indian man presented to our hospital with jaundice 8 months after finishing R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) for diffuse large B cell non-Hodgkin lymphoma. His serum transaminase concentrations were >100 times the upper limit of normal. He had no other risk factors for liver disease. Doppler ultrasound examination of the liver was normal, but hepatitis B serology testing showed ongoing infection. Alternative diagnoses were excluded by an extended hepatitis screen, along with a comprehensive biochemical liver screen. A liver biopsy was done. This confirmed the diagnosis of reactivated hepatitis B and excluded the presence of lymphoma. Entecavir antiviral therapy was started. His clinical condition improved gradually, and he was discharged from hospital 2 weeks later. Within 6 weeks, his liver function tests had normalised. 3 months later, he remains well on antiviral therapy. His lymphoma is also in remission. It is well known that immunosuppression from chemotherapy can cause reactivation of hepatitis …