Acute Exacerbation of Hepatitis in Liver Cirrhosis with Very High Levels of alpha-Fetoprotein But No Occurrence of Hepatocellular Carcinoma
A 58-year-old female with confirmed hepatitis B-related liver cirrhosis was hospitalized for a detailed evaluation on the hepatic status in February 2003 because the AFP level checked at the outpatient department had tenaciously risen. From March 2002 to February 2003, the aminotransferases levels were slightly elevated, but the AFP level has increased from 8.55 ng/mL in March 2002 to 5,480 ng/mL in February 2003 (). At the time of the admission, she presented with no specific complaint. The physical examination showed no abnormalities except mild icteric sclerae. She had no past history of variceal bleeding, ascites, encephalopathy or intake of herbs or alcohol before her admission. The initial serology revealed macrocytic hyperchromic anemia (Hb 11.1 g/dL, Hct 27%) and thrombocytopenia (29,000 mm3), moderate hypoalbuminemia (2.7 mg/dL), mild hyperbilirubinemia (total bilirubin 2.3 mg/dL) and elevated aminotransferase levels (AST/ALT 130/42 IU/L). The AFP level checked on the admission was 5,480 ng/mL. The laboratory study on viral markers showed reactive HBsAg/nonreactive Anti-HBs, reactive HBeAg and an HBV-bDNA level of 5,582 pg/mL. A quantitative measurement of HbeAg was not carried out, and the other serologic findings were normal. A liver CT scan carried out during the admission confirmed liver cirrhosis with splenomegaly, ascites and portal hypertension, but there was no mass or focal lesion found in the liver (). There was no definite tumor staining on both lobes of the liver on the hepatic angiography (). A liver biopsy could not be carried out on account of the patient's adamant refusal. A post-lipiodol hepatic CT scan was subsequently undertaken 2 weeks after the angiography for detecting any hidden tumor, and it showed neither focal lesion nor lipiodol staining in the liver (). Since the initiation of antiviral therapy with Lamivudine 100 mg once a day, the aminotransferases (AST/ALT) and AFP levels have decreased approximately to 35/19 IU/L and 28.6 ng/mL, respectively, over a period of 3 months. The patient is currently still on the medication as the HBV (PCR) remains positive, but the aminotransferase levels are normal and the AFP level has fallen to 5.37 ng/mL after 9 months of therapy.