Rituximab-Associated Liver Toxicity Without Known Viral Reactivation.

Area of Science:

• Immunology
• Hepatology
• Oncology

Background:

• Rituximab is an effective immunotherapeutic agent for CD20+ B-cell neoplasms and autoimmune diseases.
• Hepatocellular injury is a known adverse effect, often linked to hepatitis B viral reactivation.
• Pre-treatment viral screening is standard practice to mitigate this risk.

Observation:

• A patient with marginal zone B-cell lymphoma developed symptomatic liver injury after rituximab therapy.
• The patient experienced a significant elevation in aminotransferase levels (15-fold increase).
• Hepatitis B viral reactivation was ruled out as the cause of liver injury.

Findings:

• This case presents a rare instance of rituximab-induced liver injury.
• The injury occurred without evidence of hepatitis B viral reactivation.
• The patient's liver injury was symptomatic and associated with marked aminotransferase elevation.

Implications:

• Clinicians should be aware of rare presentations of rituximab-induced liver injury.
• Further investigation into non-viral causes of rituximab-related hepatotoxicity may be warranted.
• Close monitoring for liver function is crucial in patients receiving rituximab, even in the absence of viral reactivation.