Case Report
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World J Hepatol. Oct 27, 2010; 2(10): 392-394
Published online Oct 27, 2010. doi: 10.4254/wjh.v2.i10.392
Acute liver failure caused by concurrent autoimmune hepatitis and hepatitis B in a 16-year old girl
Małgorzata Pawłowska, Waldemar Halota
Małgorzata Pawłowska, Waldemar Halota, Department of Infectious Diseases and Hepatology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz 85-030, Poland
Author contributions: Pawlowska M and Halota W contributed equally to this work; and Both of them were responsible for data analysis and paper writing.
Correspondence to: Małgorzata Pawłowska, MD, PhD, Professor, Department of Infectious Diseases and Hepatology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz 85-030, Poland. mpawlowska@cm.umk.pl
Telephone: +48-52-3255605 Fax: +48-52-3457195
Received: June 24, 2010
Revised: September 3, 2010
Accepted: September 10, 2010
Published online: October 27, 2010
Abstract

A 16 year-old girl was admitted to hospital because of fatigue and somnolence, nausea, epistaxis and jaundice. Physical examination revealed jaundice, an enlarged liver and tenderness of upper right abdomen. Laboratory tests revealed an increased level of acute liver failure, bilirubin, bile acids, GGTP and a decreased prothrombin ratio, with elevated gamma-globulin and IgG levels, and the presence of anti-mitochondrial M2 antibodies and HBV infection markers. The patient was diagnosed with liver failure resulting from chronic hepatitis B with an autoimmune component. The treatment consisted of steroids, azathioprine, vitamin K, low-protein diet and lactulose enemas. After undergoing a molecular test (HBV DNA 3.23 × 105 IU/mL and mutations I 204 and I 80), the treatment was modified by adding entecavir. After one month the patient was discharged in good clinical condition, with the recommendation of continued entecavir, prednisone and azathioprine. In subsequent months, no clinical deterioration or abnormal biochemical liver function test results were found, despite the discontinuation of immunosuppressive therapy after 10 mo. The patient continues entecavir therapy.

Keywords: Acute liver failure; Chronic hepatitis B; Autoimmune hepatitis; Adolescent