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Acute liver failure secondary to co-infection of Hepatitis B and HIV
Yajzeel Estevez-López1, Alan J. Romero-Sanchez1, José E. López-Ruiz2
1 Departamento de Medicina Interna, Unidad Médica de Alta especialidad No. 14 "Adolfo Ruiz Cortines", Veracruz, Veracruz
2 Universidad del Valle de Mexico, Campus Veracruz
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0009" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Ethical statement</span></p><p id="para0010" class="elsevierStylePara elsevierViewall">The identity of the patients is protected&#46; Consentment was obtained&#46;</p><p id="para0011" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Declaration of interests</span></p><p id="para0012" class="elsevierStylePara elsevierViewall">None</p><p id="para0013" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Funding</span></p><p id="para0014" class="elsevierStylePara elsevierViewall">None</p><p id="para0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Table 1</span><elsevierMultimedia ident="utbl0001"></elsevierMultimedia></p></span>"
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        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0001">Introduction and Objectives</span><p id="spara001" class="elsevierStyleSimplePara elsevierViewall">We present the case of a man with hepatitis B and HIV coinfection diagnosed by serological studies which presented acute liver failure&#59; the diagnostic approach&#44; its treatment and outcome are described&#46;</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Materials and Patients</span><p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Provide information on the association of hepatitis B virus and HIV&#46; When hepatotropic viruses are identified&#44; intentionally find the association with other factors that cause acute liver failure&#44; including infectious agents&#44; drugs&#44; and coexisting diseases&#46;</p><p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Brief description of the management to be carried out in cases of acute liver failure secondary to viral infections&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Results</span><p id="spara004" class="elsevierStyleSimplePara elsevierViewall">This is a 31-year-old man who was hospitalized when presenting in his house with jaundice syndrome&#44; abdominal pain and a drowsy state&#58;</p><p id="spara005" class="elsevierStyleSimplePara elsevierViewall">In his important history&#44; he presented consumption of crystal and marijuana in a time of 8 months&#44; high-risk sexual relations without the use of condoms&#44; multiple sexual partners &#40;Man who has Sex with Men&#41;&#44; had been evaluated 7 days before as probable autoimmune hepatitis due to present positive anti-smooth muscle antibodies 1&#58;80&#46;</p><p id="spara006" class="elsevierStyleSimplePara elsevierViewall">On admission to our unit&#44; he presented 7 days of evolution with hyposthenia&#44; hypodynamia&#44; diffuse abdominal pain&#44; being treated at the time as autoimmune hepatitis&#44; treatment with steroids was given&#44; later he presented an increase in the abdominal girth and was sent to our medical institution&#44; we received the patient in stupor state with Glasgow Coma Scale 10pts&#44; jaundiced tint in sclerae and skin&#44; due to the aforementioned history&#44; a panel was performed for hepatotrophic viruses and sexually transmitted diseases such as HIV and syphilis&#46; Finding positive HBsAg&#44; positive rapid test for HIV and positive VDRL&#44; later in his first 24 hours of admission to our unit&#44; he developed prolongation of coagulation times &#40;PT 55&#46;5&#44; aPTT 82&#46;8&#41;&#44; quantification of Total Bilirubin at 21&#46;2mg&#47;dl&#44; with liver enzymes&#46; &#62; 6 times its normal value &#40;AST 353&#44; ALT 195&#41;&#44; INR 5&#46;15&#44; and hepatic encephalopathy&#44; for which an acute liver failure approach was initiated&#44; fulfilling the defining criteria to be met&#58; BT elevation &#62;4mg&#47;dl&#44; prolonged treatment times coagulation and hepatic encephalopathy &#40;Table 1&#41;&#46;</p><p id="spara007" class="elsevierStyleSimplePara elsevierViewall">We report the case of a patient who presented an important history to guide viral infections as the cause of the acute hepatic process&#59; a complete viral panel was requested that included HIV&#44; Hepatitis A&#44; B&#44; C and VDRL Viruses&#44; where the Hepatitis Antigen was positive&#46; Hepatitis B virus surface&#44; the rapid test for HIV&#44; as well as the VDRL&#46; However&#44; in the first hours of admission&#44; defining clinical data of acute liver failure were established by presenting Prolonged coagulation times with INR &#62;1&#46;5&#44; hyperbilirubinemia &#62;5 and type A acute hepatic encephalopathy according to the Vienna classification&#44; for which reason management began with disaccharide laxatives &#40;lactulose&#41;&#44; luminal-acting antibiotics &#40;rifaximin&#41;&#44; fluid replacement &#40;30ml&#47;kg&#41; and administration of albumin &#40;1g&#47;kg&#47;day&#41;&#44; however&#44; according to mortality and survival scores&#44; the patient presented a high mortality &#40;MELD Na 49pts&#44; 90-day mortality of 66&#37;&#44; NACSELD 30-day mortality of 96&#37;&#41;&#44; according to Factor R a mixed pattern was obtained&#44; which is associated with hepatotropic virus infection among the main causes&#44; and The coexistence of HBV and HIV was established as the cause of acute liver failure&#44; since it has been established that when there is a coinfection between HBV and HIV&#44; the possibilities of acute liver failure increase to &#62;10&#37;&#44; emphasizing that in cases of liver failure acute due to viral causes&#44; other associated factors should be sought&#44; such as coinfection with other viruses&#44; since the incidence of cases of acute liver failure due to a single viral agent is less than 5&#37;&#46; It is worth mentioning that cases have been reported that establish syphilis infection as the cause of liver failure&#44; so it could even be considered a triple coinfection&#46; After 48 hours of admission&#44; the patient did not present improvement&#59; he progressed with deterioration of renal function and hepatic encephalopathy&#44; requiring advanced management of the airway&#46; This procedure is the one that his relatives did not accept and for this reason&#44; no therapy could be provided&#46; Renal replacement or management in the intensive care unit&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Conclusions</span><p id="spara008" class="elsevierStyleSimplePara elsevierViewall">This case is highly relevant since when addressing acute liver failure&#44; causes of viral origin must be intentionally sought&#46; Among the viral causes&#44; the hepatitis B virus is the one that has been most associated with developing acute liver failure&#46; It is established that up to 4&#37; of patients with HBV will develop this entity&#46; In this case&#44; the patient was infected with HIV&#44; estimating an association between both infections of 10&#37; as causes of acute liver failure&#46; These patients who present coinfection should urgently start management with HAART&#44; which presents activity for HBV&#46; However&#44; it is estimated that Coinfected patients who progress to acute liver failure have a poor prognosis and high mortality&#44; leading in most cases to death&#46; Likewise&#44; during the course of the disease&#44; the use of steroids is not recommended for the management of patients with virus infection&#46; hepatotropes&#44; so they should be avoided&#46; In this case&#44; despite having started treatment in the first 24 hours&#44; the patient did not improve and once they present renal failure&#44; renal replacement therapy and management in intensive care should be provided in order to reduce mortality and allow recovery&#46; Liver transplantation can be used as definitive treatment provided that this resource is available and when the criteria for acute liver transplantation are met&#44; the Kings College criteria and the Clichy criteria have been established for this purpose&#44; an 80&#37; success rate is estimated in cases of acute liver failure undergoing transplantation&#46;</p></span>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Uric Acid</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&#46;1 mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0026"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Triglycerides</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">58 mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0028"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Albumine</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;0 g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0030"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Total Bilirrubin</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">21&#46;2 mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0032"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Direct Bilirrubin</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">13&#46;9 mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0034"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Indirect Bilirrubin</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7&#46;3 mg&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0036"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Total Prote&#237;ns</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;6 g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0038"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Globulins</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;6 g&#47;dl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0040"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">A&#47;G Relation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0041"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0042"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Hepatitis B sAg</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Reactive 5629&#46;17 copies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0044"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Syphilis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Article information
ISSN: 16652681
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos