Year 2024 / Volume 116 / Number 4
Letter
Fulminant hepatitis due to spontaneous reactivation of virus B in an immunocompetent patient

232-233

DOI: 10.17235/reed.2023.9707/2023

Ana Suárez-Saro Fernández, Carolina Muñoz Codoceo, Raquel Muñoz Gómez, Inmaculada Fernández Vázquez,

Abstract
We present the case of a 52-year-old woman with a history of HBeAg-negative chronic hepatitis B virus (HBV) infection, viral load (VL) Z+<20,000U.l/ml with no evidence of liver fibrosis and, therefore, untreated. She presented to the emergency department with jaundice, epigastric pain, nausea, and vomiting. On admission, blood analysis revealed ALT 3982U/l, AST 3221U/l, Gamma-GT 80U/l, alkaline phosphatase 252U/l, LDH 960U/l, bilirrubin12.5mg/dl; no elevation of acute phase reactants, 141,000 platelets and coagulopathy with a prothrombin activity of 29%. Abdominal ultrasound showed no relevant findings. The serological profile revealed AgHBs+, anti-HBe+ y anti-HBc IgM+ and VL VHB>100 mills. Ul/ml, the remaining serology was negative and other causes of liver disease were ruled out. With the diagnosis of severe acute hepatitis (SAH) due to HBV reactivation (HBVR) treatment with entecavir was initiated. Given the analytical evolution (Table 1) and the appearance of encephalopathy grade I-II/IV, an urgent liver transplant was performed. The histological result of the explant was conclusive with intense interphase and lobular hepatitis with extensive areas of massive necrosis in both lobes, without hepatic fibrosis compatible with fulminant hepatitis (FH).
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References
[1] Shi, Y., & Zheng, M. (2020). Hepatitis B virus persistence and reactivation. BMJ (Clinical Research Ed.), 370, m2200. https://doi.org/10.1136/bmj.m2200
[2] Rodríguez, M., Buti, M., Esteban, R., Lens, S., Prieto, M., Suárez, E., & García-Samaniego, J. (2020). Documento de consenso de la Asociación Española para el Estudio del Hígado sobre el tratamiento de la infección por el virus de la hepatitis B (2020). Gastroenterología y Hepatología, 43(9), 559–587. https://doi.org/10.1016/j.gastrohep.2020.03.011
[3] European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu, & European Association for the Study of the Liver. (2017). EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. Journal of Hepatology, 67(2), 370–398. https://doi.org/10.1016/j.jhep.2017.03.021
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Suárez-Saro Fernández A, Muñoz Codoceo C, Muñoz Gómez R, Fernández Vázquez I. Fulminant hepatitis due to spontaneous reactivation of virus B in an immunocompetent patient. 9707/2023


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Publication history

Received: 06/05/2023

Accepted: 08/05/2023

Online First: 19/05/2023

Published: 09/04/2024

Article Online First time: 13 days

Article editing time: 339 days


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