Acute Fulminant Hepatic Failure due to Hepatitis A Virus: A Case Report

Special Article - Hepatitis A Virus

Austin Med Sci. 2018; 3(3): 1028.

Acute Fulminant Hepatic Failure due to Hepatitis A Virus: A Case Report

Satti HMA*

1Resident Registrar of Internal Medicine, SMSB, Egypt

*Corresponding author: Hassan Mohammed Abdelraheem Satti, elzamalek -khartoum-sudan -home number 1448, Egypt

Received: July 31, 2018; Accepted: September 03, 2018; Published: September 10, 2018


Fulminant liver failure (ALF) is a severe and acute injury which presents infrequently. Hepatitis A virus (HAV) occurs commonly in resource -poor regions like Sudan. It is one of the commonest cause of acute hepatitis in Sudan, but rarely progressed to ALF. A 19 year old young man presented with convulsion and loss of consciousness, He was diagnosed as fulminant hepatic failure due to hepatitis A virus infection. The patient was recovered within two weeks demonstrating a rare consequence of the ALF.

Keywords: Acute hepatic failure ALF; Hepatitis A virus; Hepatic encephalopathy; Liver transplantation


Fulminant Hepatic Failure (FHF) or acute liver failure (ALF) is defined as “the rapid development of hepatocellular dysfunction, specifically coagulopathy and mental status changes (encephalopathy) in a patient without known prior liver disease [1]. The time interval of onset of symptoms like jaundice and the appearance of encephalopathy led to several definitions of AFL [2]. Requirements to define ALF are coagulation disturbance determined by prolongation of International Normalized Ratio (INR) usually =1.5, or a prolongation of Prothrombin Time (PT) [3]. The other feature is clinical manifestations of hepatic encephalopathy [4]. Less than 1% of patients with acute HAV will develop ALF, and several co-factors will affect its evolution [5]. ALF due to HAV are more common in elder patients group and it has a worse prognosis [6]. This case describes a patient with full recovery from ALF due to HAV.

Case Presentation

A 19 year old man from Eldamar (northern Sudan) brought to the hospital after he developed one attack of convulsion lasts about five minutes aborted spontaneously followed by loss of consciousness, his condition actually started six days prior to admission with low grade fever, loss of appetite, epigastric and right upper quadrant abdominal pain, vomiting three times small amount proceed by nausea not projectile, he was seen in primary health care center and treated as simple malaria. Patient is not alcoholic or smoker, no history of paracetamol or aspirin overdose, no other drugs abuse or blood transfusion, no other medical or psychiatric illnesses history, no family history of similar condition or chronic disease. On physical examination patient looks ill, toxic, deeply jaundice, confused, not oriented in time, place or person, GCS was 8/15, in decorticate position (flexed upper limb, extended hip and knee and flexed ankle, rigidity, hyper-reflexia). There were signs of hepatic encephalopathy grade 4, BP 95/60, pulse rate 120/min regular, respiratory rate 20/min, oxygen saturation 93%, FiO2 0.21, temperature 38,5 C, fundoscopy showed papilledema. No signs of chronic liver disease, in abdominal examination liver is palpable 3 cm below the costal margin at mid clavicular line and liver span is 14 cm, in cardiopulmonary system examination there was nothing abnormal detected. Laboratory results at admission (day 0) are listed in the Table 1 below, abdominal Ultrasonography showed features of acute hepatitis and portal vein was normal, chest x ray, ECG were normal

Citation: Satti HMA. Acute Fulminant Hepatic Failure due to Hepatitis a Virus: A Case Report. Austin Med Sci. 2018; 3(3): 1028.