case_images: PMC6661963_01
case_images: The clinical course and related laboratory data. The shadowed areas indicate the reference ranges of each parameter.
case_images: jslrt-59-93-g001.jpg
case_images: PMC6661963_01_jslrt-59-93-g001.jpg
case_images: f1
case_images: 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).
case_images: 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).
case_images: jslrt-59-93-g002.jpg
case_images: PMC6661963_01_jslrt-59-93-g002.jpg
case_images: f2
case_images: 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).