Hepatocellular Carcinoma Developing in a Patient 29 Years After Achieving Sustained Virologic Response for Hepatitis...

We report a case of an 87-year-old female with a ruptured hepatocellular carcinoma (HCC). She presented with sudden epigastric and right upper abdominal pain. The physical examination revealed mild tenderness in the right upper abdomen, a positive Murphy's sign, and no jaundice. Laboratory tests showed mild anemia and elevated PIVKA-II (prothrombin induced by vitamin K absence II) levels. Abdominal ultrasound and CT revealed a large hypervascular mass in the liver, along with ascites and portal vein thrombosis. The patient had received interferon therapy for hepatitis C virus (HCV) 29 years before her presentation and blood tests and imaging examinations had confirmed sustained undetectability for HCV ribonucleic acid (RNA) and the absence of HCC for five years following treatment. HCV RNA remained undetectable at the time of her admission, and it was presumed that it had been negative for 29 years post-treatment, with no evidence of re-exposure. The patient had not attended any follow-up appointments. While there have been no reported cases of a patient developing HCC 29 years after achieving sustained virologic response (SVR), our case suggests that the absence of HCC risk is not guaranteed, even after a prolonged period post-SVR. Therefore, periodic imaging tests such as abdominal ultrasound or CT may be beneficial in detecting potential HCC, even long after achieving SVR.