Résumé
Acute fulminant hepatic failure is a condition in which a healthy liver deteriorates rapidly following an insult, resulting in the impairment of its synthetic functions. This condition is rare and is associated with high fatality rates. We report the case of a 19-year-old male who was brought to the emergency room in an unconscious state with jaundice and persistent fever for 2–3 weeks after recently commencing intravenous use of morphine. He was found to be hepatitis B surface antigen reactive, and his laboratory tests indicated severe liver dysfunction with elevated levels of serum bilirubin, aspartate transaminase, alanine transaminase, gamma-glutamyl transferase, and International normalized ratio. The patient was diagnosed with fulminant liver failure with coagulopathy and hepatic encephalopathy. The patient’s family was addressed and counseled regarding the urgent need for liver transplantation. However, due to a lack of funds and insurance, supportive treatment was the only option left. Despite all supportive measures, the patient expired within 48 h. This case highlights the importance of various socioeconomic issues involved with liver transplantation, as in a resource-limited setting, urgent transplantation seems nearly impossible. In addition, this case report raises certain ethical issues that need consideration, particularly in an injection drug use scenario. It also highlights the importance of addressing the rising issue of injection drug use among youth, particularly in the regions of Punjab.
Résumé
Introduction: In India, infectious Hepatitis is one of the major health care burdens, with viral hepatitis being the most common culprit, followed by dengue, typhoid, and malarial hepatitis. Fulminant hepatitis manifests as a sudden abnormality in liver function enzymes in a child with no prior hepatic pathology. Aims and Objects: This study was aimed at identifying the various etiological factors and correlating clinical features of viral hepatitis, and fulminant liver failure. Materials and Methods: This observational study was conducted in the paediatrics in-patient department of S.P. Medical College & P.B.M. Associated Group of Hospitals, Bikaner (Rajasthan) over a period of one year. A total of 125 children with a clinical and lab-confirmed diagnosis of acute infective hepatitis were included. Data including clinical signs, symptoms, and laboratory parameters were obtained and analyzed. Results: Most commonly affected age group was between 5-10 years with the mean age being 7.1±4.6 years. The most common etiology was hepatitis A (n=39), followed by hepatitis E (n=24) and mixed hepatitis A virus (HAV)/hepatitis E virus (HAE) infection (n=20). Other causative organisms were dengue virus (n=16), typhoid (n=13), malaria (n=9), and hepatitis B. The most common clinical symptoms were fever, jaundice, loss of appetite, and vomiting/nausea. There were some clinical features seen more commonly in case of infection with certain organisms. High frequency of diarrhoea, arthralgia, and thrombocytopenia was seen with HAV. Neurological, renal complications and high mortality were associated with HEV or HAV/HEV co-infection. While retroorbital pain and purpuric rash were exclusive with dengue, malarial hepatitis was strongly associated with pallor and altered sensorium. Conclusion: Acute infective hepatitis is most commonly caused by HAV and HEV in Western Rajasthan. It is imperative to educate the masses regarding the prevention of common infections transmissible by infected drinking water, poor hand hygiene, improper waste disposal, and open defecation.