Acute HBV Related ALF- Successful Outcome with Oral Antiviral Treatment

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.

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Etiologies and Outcomes of Acute Liver Failure in a Spanish Community

International Journal of Hepatology ◽

10.1155/2013/928960 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Emilio Fábrega ◽

Miguel Ángel Mieses ◽

Alvaro Terán ◽

Irene Moraleja ◽

Fernando Casafont ◽

...

Keyword(s):

Liver Transplantation ◽

Hepatitis B ◽

Liver Failure ◽

Acute Liver Failure ◽

Acute Hepatitis ◽

Term Survival ◽

Acetaminophen Overdose ◽

Acute Hepatitis B ◽

Toxic Reactions ◽

Short Term Survival

Previous retrospective study (1992 to 2000) performed in Spain showed that drug toxicity, viral hepatitis, and indeterminate etiology were the most prevalent causes of acute liver failure (ALF). In the last decade, there is no information about ALF in our country. For these reasons we analyze retrospectively, in a ten-year period (2000 to 2010), the presumed causes, clinical characteristics, course, and outcome of ALF in a Spanish community. Causes of ALF were indeterminate in 4 patients (24%), acute hepatitis B infection in 4 patients (24%), drug or toxic reactions in 4 patients (24%), including one case of acetaminophen overdose, followed by miscellaneous causes. The overall short-term survival (6 weeks after admission) was 65%. Liver transplantation was performed in 11 patients with a survival of 82%. Despite fulfilling criteria, 2 patients were not transplanted because of contraindications; they both died. In summary, acute hepatitis B and indeterminate cause are still being the most frequent causes of ALF in our region, and patients with ALF have an excellent chance of survival after emergency liver transplantation. Acetaminophen overdose still represents a very rare cause of ALF in our community.

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Role of humoral immunity against hepatitis B virus core antigen in the pathogenesis of acute liver failure

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1809028115 ◽

2018 ◽

Vol 115 (48) ◽

pp. E11369-E11378 ◽

Cited By ~ 22

Author(s):

Zhaochun Chen ◽

Giacomo Diaz ◽

Teresa Pollicino ◽

Huaying Zhao ◽

Ronald E. Engle ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Liver Failure ◽

Acute Liver Failure ◽

Acute Hepatitis ◽

B Cell ◽

Core Antigen ◽

Cell Disease ◽

B Virus ◽

Acute Hepatitis B

Hepatitis B virus (HBV)-associated acute liver failure (ALF) is a dramatic clinical syndrome leading to death or liver transplantation in 80% of cases. Due to the extremely rapid clinical course, the difficulties in obtaining liver specimens, and the lack of an animal model, the pathogenesis of ALF remains largely unknown. Here, we performed a comprehensive genetic and functional characterization of the virus and the host in liver tissue from HBV-associated ALF and compared the results with those of classic acute hepatitis B in chimpanzees. In contrast with acute hepatitis B, HBV strains detected in ALF livers displayed highly mutated HBV core antigen (HBcAg), associated with increased HBcAg expression ex vivo, which was independent of viral replication levels. Combined gene and miRNA expression profiling revealed a dominant B cell disease signature, with extensive intrahepatic production of IgM and IgG in germline configuration exclusively targeting HBcAg with subnanomolar affinities, and complement deposition. Thus, HBV ALF appears to be an anomalous T cell-independent, HBV core-driven B cell disease, which results from the rare and unfortunate encounter between a host with an unusual B cell response and an infecting virus with a highly mutated core antigen.

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S3514 Acute Liver Failure Due to Acute Hepatitis B Infection

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000716104.05630.45 ◽

2020 ◽

Vol 115 (1) ◽

pp. S6-S6

Author(s):

Pujan Kandel ◽

Philip McDonald ◽

Ghassan Bachuwa

Keyword(s):

Hepatitis B ◽

Liver Failure ◽

Acute Liver Failure ◽

Acute Hepatitis ◽

Hepatitis B Infection ◽

Acute Hepatitis B

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Acute Hepatitis B with Pancreatitis and Cholecystitis Leading to Acute Liver Failure and Death

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2018.7.38344 ◽

2018 ◽

Vol 2 (4) ◽

pp. 304-308 ◽

Cited By ~ 4

Author(s):

Andrew Albert ◽

Ronald Valencia ◽

Janet Smereck

Keyword(s):

Hepatitis B ◽

Liver Failure ◽

Acute Liver Failure ◽

Acute Hepatitis ◽

Acute Hepatitis B

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Acute liver failure caused by severe acute hepatitis B: a case series from a multi-center investigation

Annals of Clinical Microbiology and Antimicrobials ◽

10.1186/1476-0711-13-23 ◽

2014 ◽

Vol 13 (1) ◽

pp. 23 ◽

Cited By ~ 6

Author(s):

Chun-ya Wang ◽

Pan Zhao ◽

Wei-wei Liu ◽

Keyword(s):

Hepatitis B ◽

Liver Failure ◽

Acute Liver Failure ◽

Acute Hepatitis ◽

Case Series ◽

Acute Hepatitis B ◽

Severe Acute Hepatitis

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Auxiliary partial orthotopic liver transplantation in acute liver failure due to hepatitis B

Transplant International ◽

10.1111/j.1432-2277.2002.tb00180.x ◽

2002 ◽

Vol 15 (7) ◽

pp. 369-373 ◽

Cited By ~ 4

Author(s):

Sanjiv Saigal ◽

Parthi Srinivasan ◽

John Devlin ◽

Bastiaan Boer ◽

Buxton Thomas ◽

...

Keyword(s):

Liver Transplantation ◽

Hepatitis B ◽

Liver Failure ◽

Acute Liver Failure ◽

Orthotopic Liver Transplantation

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A case of acute hepatitis B on the patient of primary biliary cirrhosis who was registered for the brain-death donor liver transplantation

Kanzo ◽

10.2957/kanzo.55.176 ◽

2014 ◽

Vol 55 (3) ◽

pp. 176-181 ◽

Cited By ~ 1

Author(s):

Mai Hirae ◽

Takehisa Watanabe ◽

Yoko Yoshimaru ◽

Takeshi Kawasaki ◽

Kazuhiro Izumi ◽

...

Keyword(s):

Liver Transplantation ◽

Primary Biliary Cirrhosis ◽

Hepatitis B ◽

Brain Death ◽

Acute Hepatitis ◽

Biliary Cirrhosis ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Acute Hepatitis B ◽

The Brain

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Liver failure

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0321 ◽

2020 ◽

pp. 3089-3100

Author(s):

Jane Macnaughtan ◽

Rajiv Jalan

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Hepatic Encephalopathy ◽

Liver Injury ◽

Liver Failure ◽

Acute Liver Failure ◽

Organ Failure ◽

Clinical Manifestations ◽

Chronic Liver ◽

Chronic Liver Failure

Liver failure occurs when loss of hepatic parenchymal function exceeds the capacity of hepatocytes to regenerate or repair liver injury. Acute liver failure is characterized by jaundice and prolongation of the prothrombin time in the context of recent acute liver injury, with hepatic encephalopathy occurring within 8 weeks of the first onset of liver disease. Acute-on-chronic liver failure is characterized by hepatic and/or extrahepatic organ failure in patients with cirrhosis associated with an identified or unidentified precipitating event. The commonest causes of acute liver failure are acute viral hepatitis and drugs. Acute-on-chronic liver failure is most commonly precipitated by infection, alcohol abuse, and superimposed viral infection. The main clinical manifestations are hepatic encephalopathy, coagulopathy, jaundice, renal dysfunction, and haemodynamic instability. Infection and systemic inflammation contribute to pathogenesis and critically contribute to prognosis. Specific therapy for the underlying liver disease is administered when available, but this is not possible for most causes of liver failure. Treatment is predominantly supportive, with particular emphasis on (1) correction or removal of precipitating factors; (2) if encephalopathy is present, using phosphate enemata, nonhydrolysed disaccharide laxatives, and/or rifaximin; (3) early detection and prompt treatment of complications such as hypoglycaemia, hypokalaemia, cerebral oedema, infection, and bleeding. The onset of organ failure should prompt discussion with a liver transplantation centre. The mortality of acute liver failure (without liver transplantation) is about 40%. Patients with acute liver failure who do not develop encephalopathy can be expected to recover completely. Those who recover from an episode of acute-on-chronic liver failure should be considered for liver transplantation because otherwise their subsequent mortality remains high.

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