Hairy Cell Leukemia Masquerading as Hepatitis B Cirrhosis with Splenomegaly: A Case Report

Abstract

Introduction: Hairy cell leukemia (HCL) is a rare hematologic malignancy whose symptoms, such as splenomegaly and pancytopenias, often pose diagnostic challenges. In regions with high hepatitis B virus (HBV) endemicity, HBV-related cirrhosis commonly leads to these same manifestations, which can tragically mask underlying hematological malignancies. Case Presentation: We present an atypical case of HCL in a 38-year-old woman initially misdiagnosed with HBV cirrhosis and hypersplenism. Her initial bone marrow examination was misleading. Definitive diagnosis of HCL was established through splenic histopathology, revealing pathognomonic features and CD20 positivity. Conclusions: This case highlights the critical need for vigilance against HCL misdiagnosis in HBV-positive patients presenting with unexplained cytopenias and splenomegaly, even when classic signs of cirrhosis appear apparent.