Abstract
Case report: We present a young female of fourteen years who was admitted to the hospital with short duration of Icterus, malaise, vomiting and diagnosed to be having acute hepatitis B. She went into acute liver failure as evidenced by development of hepatic encephalopathy and coagulopathy. She was managed on lines of hepatic encephalopathy along with oral antiviral treatment. She recovered successfully and was discharged after two weeks in heamodynamically stable condition. After a gap of six months, she became Hepatitis B surface (HbsAg) & hepatitis B e-antigen (HbeAg) negative and Hepatitis B Virus DNA (HBV DNA) was undetectable with normal liver function tests. She is on regular follow up for last one year and is absolutely normal. Conclusion: Acute hepatitis B can go into acute liver failure in 1% of cases, treatment for which includes liver transplantation and oral antiviral treatment which is especially helpful in cases who cannot afford liver transplantation, as was in our case.
Highlights
Hepatitis B virus (HBV) infection rarely cause Fulminant liver failure but has a poor prognosis with high mortality rate which aggravates in presence of co-infection with hepatitis D virus (HDV)
A quick immune response is more closely related to the development of fulminant liver failure than to increased viral replication [1]. This means that the early turn of HbsAg to anti-HBs might be involved in the pathogenesis of fulminant liver failure [2]
Copy rights@ Parveen Malhotra et al N-acetyl cystiene, Mannitol, raising of head end to 30 degrees and other supportive therapy. She responded to treatment and was out of encephalopathy in five days and her coagulation profile and liver function tests started improving as evidenced by decreasing trends of serum bilirubin and transaminases
Summary
The literature on treatment benefit are not clear in fulminant hepatitis B but immediate treatment is always justifiable when a patient presents with acute liver failure because of the maximum of reasonable expectation of benefit and the absence of major adverse events from therapy. More researches are required regarding use of oral antiviral in HBV related acute liver failure and acute severe hepatitis, so as to determine clearly their role in the management of above life threatening conditions. The use of antiviral in these conditions becomes more important in developing country like India where there is limited availability of liver transplantation but majority of needy patients cannot afford due to financial constraints
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