PMC6661963_01
The clinical course and related laboratory data. The shadowed areas indicate the reference ranges of each parameter.
jslrt-59-93-g001.jpg
PMC6661963_01_jslrt-59-93-g001.jpg
f1
After 2 cycles, slight increases in liver enzymes were noted on laboratory testing; aspartate aminotransferase (AST) 80 IU/L (reference range: 5-40), alanine aminotransferase (ALT) 123 IU/L (reference range: 5-35) and gamma-glutamyl transpeptidase (GGT) 22 IU/L (reference range: 8-64) (Fig. 1). ALT and GGT levels increased to 550, 434 and 460 IU/L, respectively (Fig. 1). As rituximab was the only drug used at this point, we considered it to be the cause of liver injury and it was discontinued. At this time, the percentage of eosinophils slightly increased (0.3% to 3.2%). His AST, ALT and total bilirubin levels markedly increased to 973 IU/L, 407 IU/L and 8.1 mg/dL (reference range: 0.3-1), respectively, and he developed jaundice and ascites (Fig. 1).
Histopathology of the liver specimen. The panels show (A) (B) hematoxylin-eosin (HE) staining and (C) Masson trichrome staining (MT) at the indicated magnification x100 (A), x400 (B) and x100 (C).
jslrt-59-93-g002.jpg
PMC6661963_01_jslrt-59-93-g002.jpg
f2
On liver biopsy, lymphoma cells were not detected in the specimen and no evidence of viral infection, such as intranuclear or cytoplasmic inclusion bodies, was observed (Fig. 2A-C).