An Atypical Association of Hepatitis C Infection With Extranodal Marginal Zone Lymphoma

Abstract

Marginal zone lymphomas (MZLs) are an uncommon form of B-cell non-Hodgkin lymphomas (NHLs). They can be further classified into three specific groups depending on the tissue involved: extranodal MZL or mucosa-associated lymphatic tissue (MALT) lymphoma, splenic MZL and nodal MZL. MALT lymphoma is among the most common malignant lymphomas of the ocular adnexa as seen with this case. Infectious agents play a decisive role in the development of these ocular adnexal lymphomas. Chlamydia psittaci, HSV1, HSV2, ADV8 and ADV19 are usually linked with these lymphomas. We present a rare case of extranodal MZL of the ocular adnexa with nodal and bone marrow involvement likely due to hepatitis C infection. Hepatitis C infection has been associated with diffuse large cell lymphoma, small lymphocytic lymphoma, splenic and nodal MZL, but to the best of our knowledge, there are very few documented cases of extranodal MZL of the ocular adnexa with hepatitis C infection. The paucity of evidence of this association makes our case rare and also offers a different therapeutic outcome with treatment of hepatitis C infection in conjunction with the traditional chemotherapy.