Liver Transplant in an Unusual Case of Acute Fulminant Hepatic Failure: A Case Report

Abstract

Yellow phosphorus ingestion causing acute fulminant hepatic failure is a serious condition. The establishment of health measures to monitor and prevent yellow phosphorus poisoning is of utmost importance because there is no known cure for the condition. To prevent phosphorus poisoning, it is crucial to raise awareness among the general population about its potential fatality, educate primary care physicians about the delayed onset toxidrome, and take precautions to ensure careful monitoring and reporting. Herein, we present a case of case of a 33-year-old male who consumed 30 grams of rat poison {Yellow Phosphorus (YP)} while under the influence of alcohol. He presented to us on day 5 with icterus and bilateral subconjunctival haemorrhage. Laboratory investigations revealed severely deranged liver function tests and raised Prothrombin Time (PT)/International Normalised Ratio (INR), indicating acute fulminant hepatic failure. The patient was started on N-acetyl cysteine, vitamin K, and received fresh frozen plasma transfusion. Despite treatment, on day 3, the patient developed grade 4 Hepatic Encephalopathy (HE) and the laboratory parameters worsened. Close monitoring revealed further deterioration, leading to the decision for emergency orthotopic Liver Transplantation (LT) on day 7. Following the transplant, the patient's liver function tests showed improvement. The subconjunctival haemorrhage and icterus resolved completely on day 3 post-transplantation. The patient was extubated on day 3 and discharged on day 5 post-transplantation. Regular follow-up appointments were uneventful. In conclusion, the present case report highlights the successful management of a patient with acute fulminant hepatic failure through early hepatic transplantation. It emphasizes the importance of prompt recognition, appropriate treatment, and timely transplantation in improving patient outcomes.