Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2021; 9(28): 8492-8497
Published online Oct 6, 2021. doi: 10.12998/wjcc.v9.i28.8492
Extremely high titer of hepatitis B surface antigen antibodies in a primary hepatocellular carcinoma patient: A case report
Jing-Jing Han, Yu Chen, Yu-Chen Nan, Yong-Lin Yang
Jing-Jing Han, Yu Chen, Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Yu-Chen Nan, Department of Preventive Veterinary Medicine, College of Veterinary Medicine, Northwest A&F University, Yangling 712100, Shaanxi Province, China
Yong-Lin Yang, Department of Infectious Disease, Taizhou Clinical Medical School of Nanjing Medical University (Taizhou People's Hospital), Taizhou 225300, Jiangsu Province, China
Yong-Lin Yang, Department of General Practice, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China
Author contributions: Yang YL was the patient’s attending, and responsible for making critical revisions related to important intellectual content of the manuscript; Han JJ reviewed the literature and contributed to manuscript drafting; Nan YC and Chen Y were responsible for revision of the manuscript for important intellectual content; All authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Yong-Lin Yang, MD, Chief Doctor, Department of Infectious Disease, Taizhou Clinical Medical School of Nanjing Medical University (Taizhou People's Hospital), No. 210 Yingchun Road, Hailing District, Taizhou 225300, Jiangsu Province, China.
Received: April 1, 2021
Peer-review started: April 1, 2021
First decision: May 27, 2021
Revised: May 28, 2021
Accepted: August 11, 2021
Article in press: August 11, 2021
Published online: October 6, 2021

Hepatocellular carcinoma (HCC) may be caused by hepatitis B virus (HBV) infection. Post-infection recovery-associated changes of HBV indicators include decreased hepatitis B surface antigen (HBsAg) level and increased anti-HBsAg antibody titer. Testing to detect HBV DNA is conducted rarely but could detect latent HBV infection persisting after acute infection and prompt administration of treatments to clear HBV and prevent subsequent HBV-induced HCC development. Here, we present an HCC case with an extremely high anti-HBsAg antibody titer and latent HBV infection.


A 57-year-old male patient with abdominal pain who was diagnosed with primary HCC presented with an extremely high level (over 2000 ng/mL) of serum alpha-fetoprotein. Abdominal B-ultrasonography and computed tomography scan results indicated focal liver lesion and mild splenomegaly. Assessments of serological markers revealed a high titer of antibodies against hepatitis B core antigen (anti-HBcAg antibodies), an extremely high titer (1000 mIU/mL) of hepatitis B surface antibodies (anti-HBsAg antibodies, anti-HBs) and absence of detectible HBsAg. Medical records indicated that the patient had reported no history of HBV vaccination, infection or hepatitis. Therefore, to rule out latent HBV infection in this patient, a serum sample was collected then tested to detect HBV DNA, yielding a positive result. Based on the aforementioned information, the final diagnosis was HCC associated with hepatitis B in a compensated stage of liver dysfunction and the patient was hospitalized for surgical treatment.


A rare HCC case with high serum anti-HBsAg antibody titer and detectable HBV DNA resulted from untreated latent HBV infection.

Keywords: Hepatocellular carcinoma, Hepatitis B virus DNA, Hepatitis B surface antibody, Hepatitis B core antibody, Occult hepatitis B virus infection, Case report

Core Tip: Generally, hepatitis B surface antigen turning negative and the occurrence of hepatitis B surface antibody have been regarded as indicators of virus clearance and clinical recovery in hepatitis B patients. Here, we present a case of hepatis B virus (HBV) infection-associated hepatocellular carcinoma with extreme high titer of hepatitis B surface antibodies, up to 30396 mIU/mL, and failure to eliminate HBV. This case provides details of a diagnostic process for HBV infection-associated hepatocellular carcinoma that should be considered in patients with highly elevated titer of anti-HBs.