# Rituximab-Associated Liver Toxicity Without Known Viral Reactivation

## TL;DR

A patient developed severe liver injury after receiving rituximab, but no viral reactivation was found as a cause.

## Contribution

This case report highlights a rare instance of rituximab-induced liver toxicity without viral reactivation.

## Key findings

- A patient with marginal zone B-cell lymphoma experienced significant liver injury after rituximab treatment.
- No evidence of viral reactivation was found despite the liver injury.
- This case suggests rituximab can cause hepatotoxicity independent of viral reactivation.

## Abstract

Rituximab is a targeted immunotherapeutic agent that has demonstrated efficacy in treating CD20+ B-cell neoplasms as well as other lymphoproliferative and autoimmune disorders. A major adverse effect of rituximab is hepatocellular injury attributed to hepatitis B viral reactivation, necessitating viral titers before treatment. In this case report, we illustrate the rare presentation of a patient with marginal zone B-cell lymphoma who experienced symptomatic liver injury with a peak 15-fold aminotransferase elevation following his first dose of rituximab, without evidence of viral reactivation.