Z Gastroenterol 2018; 56(05): e45-e46
DOI: 10.1055/s-0038-1654654
POSTER
Hepatologie
Georg Thieme Verlag KG Stuttgart · New York

Fulminant Liver Failure and Impaired hepatitis A virus clearance

M Effenberger
1   Department of Internal Medicine I, Gastroenterology, Hepatology and Endocrinology, Universitiy Hospital Innsbruck, Innsbruck, Austria
,
H Zoller
1   Department of Internal Medicine I, Gastroenterology, Hepatology and Endocrinology, Universitiy Hospital Innsbruck, Innsbruck, Austria
,
H Tilg
1   Department of Internal Medicine I, Gastroenterology, Hepatology and Endocrinology, Universitiy Hospital Innsbruck, Innsbruck, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
09 May 2018 (online)

 

Hepatitis A infection is caused by the hepatitis A virus (HAV). Hepatitis A has a much more serious course in adults than in children. Fulminant liver failure in adults occurs in less than 1 percent of the cases and is most commonly associated with other underlying liver diseases. We report an adult developing a fulminant liver failure due to a recent HAV infection followed by a very protracted clinical course accompanied by severely delayed clearance of the virus. A 44-year-old woman, with a medical history of arthritic psoriasis under methotrexate therapy for 2 years presented with acute liver injury for 4 days. The acute liver failure deteriorated 3 days later with rising bilirubin and INR (3.5). PCR-testing for hepatitis B-E was negative, serologic tests excluded other virus infections or autoimmune hepatitis. Antibody and PCR-testing for hepatitis A was highly positive. On day six of hospitalization the patient's symptoms improved, under ongoing supportive therapy. HAV-RNA was still detectable, and signs of hepatitis were still present, a therapy with aprednisolone and ribavarin was initiated. After 28 days she could be dismissed, jaundice was present for 32 days more days. HAV-RNA was detectable for 94 days and serum anti-HAV IgM was still positive, 9 months after infection. The clinical course and laboratory findings are in accordance with our diagnosis of protracted hepatitis A. Methotrexate pretreatment is the most possible reason to be responsible for this unusual course, and we strongly encourage for testing and subsequent vaccination against HAV and HBV prior to long term immunosuppressive therapy in patients with enhanced risk of hepatitis virus infection.