8. A case of liver cirrhosis due to occult hepatitis B virus infection in an intermediate endemicity region of Northern India

Abstract

Background: The presence of hepatitis B virus genome in HBsAg negative subjects is known as occult hepatitis B viral infection. Occult hepatitis B is caused by persistent low level of viral replication. Case Summary: We present a case of 63-year-old male, non-alcoholic, nonsmoker who came with complaint of blood in vomitus. There was no history of yellow discoloration of eyes, abdominal distension, weight loss, decreased appetite, drug intake or blood transfusion. On examination, pallor was present with no signs of liver failure. On per abdominal examination, liver was palpable with no features suggestive of ascites. Rest of systemic examination was within normal limits. His biochemical work up showed, dimorphic anemia (Hb- 6.1 gm/dL) with thrombocytopenia (APC- 90000/cumm). Liver and kidney function tests were within normal limits. Viral markers (HIV/HBsAg/Anti HCV) were nonreactive and there was no evidence of KF rings on slit lamp examination. USG abdomen showed liver of size 15 cm with irregular outline, with hypertrophy of left lobe and caudate lobe. The portal vein diameter was 12 mm and hepatic vein doppler showed normal flow with biphasic wave pattern. CECT abdomen showed liver cirrohosis with portal hypertension with multiple collaterals at porta, peripancreatic, splenic hilum, perigastric and gastroesophageal junction, with splenomegaly and mild ascites. Before labeling as a case of cryptogenic cirrohosis, total Anti HBc antibodies were advised and came out to be positive. Subsequently, raised HBV DNA (14910 copies/ml) confirmed the diagnosis of occult hepatitis B. Conclusions: Before labeling as a case of cryptogenic cirrohosis, total Anti HBc antibodies should be done to rule out occult HBV infection. The authors have none to declare.