Title : Acute-on-chronic liver failure triggered by dengue infection in a patient with probable autoimmune hepatitis
Abstract:
This clinical case describes the complex management of autoimmune hepatitis (AIH), a chronic inflammatory liver disease of idiopathic origin that can progress to cirrhosis or liver failure if not diagnosed and treated promptly. In tropical regions, infections such as dengue may worsen the course of liver diseases. We report the case of a 48-year-old woman with a history of mammary tuberculosis, type 2 diabetes, confirmed dengue infection, fever, and intermittent use of herbal infusions. She presented with dark urine, acholia, jaundice, and right upper quadrant pain lasting 17 days. Laboratory tests showed elevated liver enzymes, coagulation abnormalities, positive antinuclear antibodies (ANA), and abdominal imaging findings consistent with chronic liver disease and cirrhosis. Despite corticosteroid treatment, she progressed to fulminant hepatic failure and passed away . AIH was considered the main contributing factor, given its higher prevalence in women and its interaction with triggers such as viral infections. Dengue, particularly serotypes DENV1 and DENV3, has high liver tropism and may cause anything from asymptomatic transaminase elevation to fulminant liver failure. The diagnosis of AIH relies on serology and clinical criteria; in this case, only ANA with a speckled pattern was detected, and specific autoantibodies like anti-LC1 could not be tested due to resource limitations. Initial treatment was based on corticosteroids. An integrated diagnostic approach, including liver biopsy, is essential, as is health education to raise awareness of AIH as a potential cause of liver failure in patients with recent viral infections.
