Occult Hepatitis B Virus Related Decompensated Cirrhosis of Liver in Young Males: First Report of Two Cases from Bangladesh

Cryptogenic cirrhosis is a diagnosis of exclusion. Polymerase chain reaction (PCR) has demonstrated persistent hepatitis B virus (HBV) infection in serum and liver tissue of HBsAg-negative chronic hepatitis, HBsAg-negative cirrhosis, and HBsAg-negative HCC patients. The entity of occult HBV infection is well established. We report two patients with occult HBV related decompensated cirrhosis of liver for the first time from Bangladesh. The first patient is a young male with jaundice and hepato-splenomegaly. The second patient is also a young male with ascites. Both had altered liver function tests. Diagnosis of decompensated cirrhosis of liver was established in both cases and in both the etiology was identified by PCR to be occult HBV infection. In areas with high prevalence of HBV, a diagnosis of "cryptogenic" cirrhosis based on HBsAg testing alone is not adequate. The so called "cryptogenic" but actually occult HBV cirrhotics are suitable candidates for antiviral treatment. Occult HBV infection must be considered in all patients with cryptogenic cirrhosis of liver in areas where HBV infection is prevalent.