Title : Fulminant hepatic failure associated with hepatitis A virus in a previously healthy patient: Case report
Abstract:
The Hepatitis A virus usually causes a self-limiting disease, with fulminant hepatic failure occurring in less than 1% of cases. A 40-year-old white male patient, self-employed, with a personal history of cholecystectomy 11 months prior, with no other comorbidities or ongoing medication use, was admitted to an emergency care unit with myalgia, fever, and nausea that had been present for four days. Laboratory tests showed elevated liver enzymes and bilirubin at the expense of the direct fraction. Total abdominal tomography revealed signs suggestive of diffuse hepatic steatosis and mild splenomegaly. After five days of hospitalization, he developed clinical deterioration and progression to hepatic encephalopathy and was transferred to an infectious disease hospital due to suspected acute viral hepatitis. Upon admission to the intensive care unit, he presented with ascites and severe hepatic encephalopathy. Laboratory tests showed prolonged prothrombin time (increased international normalized ratio), elevated direct bilirubin, falling liver enzymes, and hypoalbuminemia. Child-Pugh score of 14 points (classification C) and Model for End-Stage Liver Disease score of 3.0 with 28 points. Serology for human immunodeficiency virus, hepatitis B, and hepatitis C were nonreactive, while serology for hepatitis A was positive (IgM antibody). Supportive measures for severe liver failure were initiated, with sparing intravenous hydration and use of lactulose due to the absence of signs of intracranial hypertension. He showed significant clinical and laboratory improvement, with discharge from the intensive care unit after four days and hospital discharge after seven days of hospitalization.
