{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T03:28:26Z","timestamp":1772249306757,"version":"3.50.1"},"reference-count":48,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,6,15]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:p>A 93-year-old man was admitted with 1 week of frank jaundice and abdominal pain. His medical history included diffuse large B-cell lymphoma treated with rituximab and cyclophosphamide, hydroxydaunomycin, oncovin and prednisolone (R-CHOP) chemotherapy 10 months prior. His investigations revealed marked hyperbilirubinemia with a total bilirubin of 355 \u03bcmol\/L, along with a 17-fold elevation in alanine transaminase and impaired hepatic synthetic function. He tested hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (HBsAb) negative, hepatitis B core antibody (HBcAb) positive and had elevated hepatitis B virus DNA level at 13\u2009691 IU\/L. This was in the setting of radiological evidence of suspected cirrhosis. He was later found to have tested positive for HBcAb and negative for HBsAg and HBsAb prior to chemotherapy, but had not received antiviral prophylaxis. He was diagnosed with fulminant hepatitis secondary to delayed hepatitis B reactivation in the setting of rituximab. Hepatitis B reactivation and the role of screening and antiviral prophylaxis in isolated HBcAb-positive patients is reviewed.<\/jats:p>","DOI":"10.1136\/bcr-2021-243526","type":"journal-article","created":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T11:51:12Z","timestamp":1625831472000},"page":"e243526","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Liver failure from delayed hepatitis B reactivation in anti-HBc-positive patient following rituximab for B-cell lymphoma"],"prefix":"10.1136","volume":"14","author":[{"given":"Branko","family":"Borojevic","sequence":"first","affiliation":[{"name":"General Medicine, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayushi","family":"Chauhan","sequence":"additional","affiliation":[{"name":"General Medicine, Eastern Health, Box Hill, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"Patterson","sequence":"additional","affiliation":[{"name":"Gastroenterology and General Medicine, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,7,9]]},"reference":[{"key":"2025082709564167000_14.7.e243526.1","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1002\/cld.883","article-title":"Reactivation of hepatitis B virus: a review of clinical guidelines","volume":"15","author":"Myint","year":"2020","journal-title":"Clin Liver Dis"},{"key":"2025082709564167000_14.7.e243526.2","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0132426","article-title":"Risk of severe acute exacerbation of chronic HBV infection cancer patients who underwent chemotherapy and did not receive anti-viral prophylaxis","volume":"10","author":"Shih","year":"2015","journal-title":"PLoS One"},{"key":"2025082709564167000_14.7.e243526.3","doi-asserted-by":"crossref","first-page":"219","DOI":"10.3350\/cmh.2016.0024","article-title":"Prevention of hepatitis B reactivation in the setting of immunosuppression","volume":"22","author":"Pattullo","year":"2016","journal-title":"Clin Mol Hepatol"},{"key":"2025082709564167000_14.7.e243526.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-007-0396-1"},{"key":"2025082709564167000_14.7.e243526.5","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2008.18.0182"},{"key":"2025082709564167000_14.7.e243526.6","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-009-0806-7"},{"key":"2025082709564167000_14.7.e243526.7","doi-asserted-by":"crossref","first-page":"2357","DOI":"10.3109\/10428194.2014.991922","article-title":"Lymphocyte\/monocyte ratio and cycles of rituximab-containing therapy are risk factors for hepatitis B virus reactivation in patients with diffuse large B-cell lymphoma and resolved hepatitis B","volume":"56","author":"Wu","year":"2015","journal-title":"Leuk Lymphoma"},{"key":"2025082709564167000_14.7.e243526.8","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2003.50220"},{"key":"2025082709564167000_14.7.e243526.9","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-008-0585-6"},{"key":"2025082709564167000_14.7.e243526.10","doi-asserted-by":"publisher","DOI":"10.1080\/1042819031000151923"},{"key":"2025082709564167000_14.7.e243526.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.03.021"},{"key":"2025082709564167000_14.7.e243526.12","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29800"},{"key":"2025082709564167000_14.7.e243526.13","doi-asserted-by":"crossref","first-page":"6484","DOI":"10.3748\/wjg.v22.i28.6484","article-title":"Prevention and management of hepatitis B virus reactivation in patients with hematological malignancies treated with anticancer therapy","volume":"22","author":"Law","year":"2016","journal-title":"World J Gastroenterol"},{"key":"2025082709564167000_14.7.e243526.14","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.50160"},{"key":"2025082709564167000_14.7.e243526.15","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2014.10.039"},{"key":"2025082709564167000_14.7.e243526.16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-043672"},{"key":"2025082709564167000_14.7.e243526.17","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.12305"},{"key":"2025082709564167000_14.7.e243526.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2014.10.032"},{"key":"2025082709564167000_14.7.e243526.19","unstructured":"Australian Technical Advisory Group on Immunisation (ATAGI) . 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