Splenic Marginal Zone Lymphoma in a Chronic Hepatitis B Patient: A Rare Case Report and a Literature Review

Abstract

BACKGROUND: Hepatitis B virus (HBV) is an important global public health problem with significant morbidity and mortality. Chronic HBV infection is a dynamic process with the risk of progression to cirrhosis and hepatic carcinoma (HCC). Although HCC is currently the main concern for diagnosed chronic hepatitis B (CHB), these patients are also considered in high risk for developing B-cell non-Hodgkin lymphoma (B-NHL). The increased risk for B-NHL is well- documented in chronic hepatitis C patients, while in HBV patients are still subject of studies and the most common form of B-NHL reported in these studies is diffuse large B-cell lymphoma (DLBCL). CASE REPORT: We are reporting the case of a patient with chronic HBV infection complicated with a rare type of B-NHL, a splenic marginal zone lymphoma (SMZL) and through a literature review aim to assess the importance of being aware of the increased risk of lymphoproliferative disorders in chronic HBV patients, asses the role of laboratory follow-up for the early diagnose of this complication, and also recommend testing for HBV infection in all patients diagnosed with B-NHL not only in DLBCL forms but also in rare forms like SMZL. CONCLUSION: CHB infection has an increased risk for B-NHL not only for the aggressive DLBCL form which is the most common form encountered but also for SMZL which is a rare indolent form of B-NHL with a better prognosis. Laboratory monitoring has a great value to the early detection of B-cell clonal expansion. In all SMZL, patients are recommended screening for HBV, because treatment with antivirals may regress lymphoma and also prevent reactivation of HBV in case of chemotherapy, especially rituximab.