Sword of Damocles: a hard blow from hepatitis A.

Introduction and Objectives

The global incidence of liver failure associated with hepatitis A virus infection is reported in 0.5% of all cases, among which the associated risk factors are age over 40 years and pre-existing liver disease, and about 40% of the cases require liver transplantation.

Materials and Patients

A 29-year-old man, previously healthy and without any identified risk factors. One week prior to his admission, after eating shellfish, he presented intense colicky abdominal pain without radiation, nausea, vomiting, abundant non-steatorrhea, diarrheal stools, and unquantified fever.

He went to a private clinic where unspecified medication was administered and an abdominal ultrasound was performed, where hepatomegaly was reported. Laboratory studies showed alteration in liver biochemistry integrating hepatocellular damage 10 times above the normal upper limit as well as prolongation of coagulation times. Three days after the onset of the symptoms, generalized jaundice, aggressiveness and drowsiness were added, for which he was referred to our hospital unit. Upon admission, he presented a stupor and was taken to invasive mechanical ventilation.

Results

The approach was started, and results were reactive for IgM to hepatitis A virus and non-reactive for HIV, hepatitis B and C viruses. He remained intubated for five days and presented acute kidney injury that required hemodialysis and coagulopathy without presenting clinical data of bleeding; subsequently, he gradually presented clinical and laboratory improvement, and after 12 days of hospitalization, he was discharged home.

Conclusions

In the approach to acute liver failure, it is important to consider infection by the hepatitis A virus, because, despite the fact that the incidence of infection in Mexico is 5%, not all of the Mexican population has access to the vaccination and is the only effective measure to prevent this disease.

In the case of our patient, he did not present these risk factors and had a spontaneous recovery. Within the approach to fulminant hepatitis, it is important to consider infection by the hepatitis A virus, because even though the incidence in our country is 5%, not the entire Mexican population has access to vaccination.

Ethical statement

The identity of the patients is protected. Consentment was obtained.

Declaration of interests

None

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Figure 1. Cases and incidence per year of hepatitis A virus infection in Mexico

Figure 2. Cases and incidence by state of hepatitis A virus infection