Acute-on-chronic liver failure induced by antiviral therapy for chronic hepatitis C: A case report

Abstract

BACKGROUND

There have been no reports of acute-on-chronic liver failure (ACLF) during treatment of chronic hepatitis C (CHC) with direct-acting antivirals (DAAs).

CASE SUMMARY

We report a 50-year-old male patient with CHC. The patient sought medical attention from the Department of Infectious Diseases at our hospital due to severe yellowing of the skin and sclera, which developed 3 mo previously and attended two consecutive hospitals without finding the cause of liver damage. It was not until 1 mo ago that he was diagnosed with CHC at our hospital. After discharge, he was treated with DAAs. During treatment, ACLF occurred, and timely measures such as liver protection, enzyme lowering, anti-infective treatment, and suppression of inflammatory storms were implemented to control the condition.

CONCLUSION

DAA drugs significantly improve the cure rate of CHC. However, when patients have factors such as autoimmune attack, coinfection, or unclear hepatitis C virus genotype, close monitoring is required during DAA treatment.

Keywords: Chronic hepatitis C; Acute-on-chronic liver failure; Direct acting antivirals; Sofosbuvir-velpatasvir; Case report

Core Tip: The advent of direct-acting antivirals (DAAs) for chronic hepatitis C (CHC) has improved the rate of sustained virology response, resulting in clinical cure of CHC. We report a rare case of CHC where the patient developed acute-on-chronic liver failure during DAA therapy. Based on comprehensive analysis, the genotype of hepatitis C virus in this patient was unclear, and he was in an autoimmune hyperimmune state at the time and was coinfected with bacteria. When CHC is combined with the above conditions, close monitoring should be carried out during treatment to avoid a poor prognosis.