Hepatitis C Cirrhosis With Non-hodgkin's Lymphoma:A Case Report And Review Of The Literature

Objective: Hepatitis C virus(HCV)is a leading cause of liver-related mortality worldwide.Chronic HCV infection is not only a major cause of liver cirrhosis and hepatocellular carcinoma(HCC),but is also associated with several extrahepatic manifestations including mixed cryoglobulinemia,type 2 diabetes,B-cell non-Hodgkin's lymphoma(NHL),Chronic HCV infection is related with an increased risk of NHL,diffuse large B cell lymphoma(DLBCL)and marginal zone lymphoma(MZL)are the two most frequent HCV-associated lymphomas.The role of HCV virus in the pathogenesis of lymphoproliferative diseases is confirmed by a large number of epidemiological studies,as well as by the effectiveness of antiviral therapy in patients with NHL.Antiviral therapy is the first-line treatment for HCV-related indolent NHL whereas DLBCL requires immediate start of chemoimmunotherapy,HCV infection may influence the short-term outcome of B-NHL because of the emergence of severe hepatic toxicity during immunochemotherapy,Liver toxicity is frequently cause of chemoimmunotherapy dose delays or discontinuation in HCV patients thus increasing the risk of lymphoma recurrence.This article describes the clinical manifestation,diagnostic basis,prognosis and treatment of HCV-positive NHL cases,in order to improve the understanding of NHL and the level of diagnosis and treatment.Method: A case of hepatitis C cirrhosis with non-Hodgkin's lymphoma in the Second Infection Department of the Third Hospital of Hebei Medical University was selected.The epidemiology,pathogenesis,diagnosis basis,prognosis and treatment plan of hepatitis C cirrhosis with non-Hodgkin's lymphoma were discussed in combination with related literature at home and abroad.Results: The patient,female 71-year-old,had a history of blood transfusion,reported intermittent loss of appetite,edema of both lower limbs for 25 years,fever,systemic edema for 2 months and aggravation for 1 month.The patient with HCV infection had a long history and was diagnosed as non-Hodgkin lymphoma by pathological results.Conclusion: The patient's condition progresses slowly on the basis of HCV infection,which eventually leads to the occurrence of NHL.Three general theories have emerged to understand the HCV-induced transformation process:1)Continuous external stimulation of lymphocyte receptors by viral antigens and consecutive proliferation;2)HCV replication in B-cells with oncogenic effect mediated by intracellular viral proteins;3)Permanent B-cell damage – the so called “hit and run” theory.