• Yu-Che Chuang, Ying-Ren Chen, and Te-Hui Kuo.
• Education Center, National Cheng Kung University Hospital.
• Medicine (Baltimore). 2021 Feb 19; 100 (7): e24792e24792.

IntroductionOccult hepatitis B virus (HBV) infection, defined as negative hepatitis B surface antigen (HBsAg) but detectable HBV DNA in serum and liver tissue, has very rarely been described in cryoglobulinemia (CG) patients. This case report sheds light on the possible link between occult HBV infection and CG.Patient ConcernsA 76-year-old man presented with rapidly deteriorating renal function within 1 year.DiagnosisCryoglobulinemic glomerulonephritis was diagnosed through renal biopsy. Initially, the patient tested negative for HBsAg, but a low HBV viral load was later discovered, indicating an occult HBV infection. Further studies also revealed Waldenström macroglobulinemia (WM).InterventionsWe treated the patient as WM using plasma exchange and rituximab-based immunosuppressive therapy.OutcomesAfter 1 cycle of immunosuppressive treatment, there was no improvement of renal function. Shortly after, treatment was discontinued due to an episode of life-threatening pneumonia. Hemodialysis was ultimately required.ConclusionFuture studies are needed to explore the link between occult HBV infection and CG, to investigate the mediating role of lymphomagenesis, and to examine the effectiveness of anti-HBV drugs in treating the group of CG patients with occult HBV infection. We encourage clinicians to incorporate HBV viral load testing into the evaluation panel for CG patients especially in HBV-endemic areas, and to test HBV viral load for essential CG patients in whom CG cannot be attributed to any primary disease.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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