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Occult hepatitis B infection (OBI) is characterized by absent hepatitis B surface antigen (HBsAg), low or undetectable serum hepatitis B viral DNA (HBV-DNA), and detectable DNA in the liver. There is debate over whether OBI increases the risk of hepatocellular carcinoma (HCC). We present a patient with negative HBsAg and a large HCC tumor who underwent a large right hepatic lobectomy. Initially, the etiology of HCC was unknown, but through more sensitive molecular testing, it was believed to be due to OBI. In this case report, we discuss the patient’s clinical course, the effect of antiviral therapy, mechanism of carcinogenesis in OBI, and the need for more rigorous HBV DNA assay testing for the detection of OBI.

Long-term survival of occult hepatitis B associated hepatocellular carcinoma following surgery and antiviral therapy