A Case of Necrotic Hepatocellular Carcinoma in a Young Male with Hepatitis B

Excerpt

A 29-year-old West African male presented to the hepatology clinic after testing positive for hepatitis B surface antigen (HBsAg) during routine screening. Positive HBsAg and negative HBsAb distinguished between infection and immunity. Further testing showed positive HBeAg, HBeAb, and HBcAb (IgG and IgM), HB viral load of 1,698,244 IU/mL, and normal liver enzymes, consistent with phase 1 chronic hepatitis B. Liver ultrasound (US) done to evaluate for cirrhosis and screen for hepatocellular carcinoma (HCC) showed neither pathology. Given the absence of cirrhosis and normal liver enzymes, he did not meet criteria for HBV infection treatment. He was instructed to follow-up with repeat LFTs (3–6 months), HBeAg (6–12 months), and liver US (6 months). He was also enrolled in an HCC surveillance program as he was high risk for HCC (HBV positive and older than 20 years with African ethnicity). He was, however, lost to follow-up. …