Acute-on-chronic liver failure due to hepatitis A infection in a patient with Metabolic Dysfunction- Associated Fatty Liver Disease. Case report.

Introduction and Objectives

Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) has steadily increased its prevalence, making it the most common liver disease in Western industrialized nations, affecting one billion people worldwide. Hepatitis A is a necro-inflammatory liver disease caused by the hepatitis A virus (HAV). Less than 1% develop acute liver failure, where 30% will require a liver transplant and 70% will require supportive therapy until recovery. Hepatic steatosis is recognized as a risk factor for developing the severe variant of HAV disease. We present this case of acute liver failure due to HAV in a patient with MAFLD.

Materials and Patients

37-year-old male with a history of systemic arterial hypertension and morbid obesity. He presented headache, fever, asthenia, adynamia, choluria and acholia with a positive viral profile for hepatitis A virus (IgM +, IgG +). Two days later, with an attack on general condition, in addition to neurological deficit with gradual deterioration of alertness. Simple computed axial tomography of the skull without alterations. Hepatosplenic Doppler ultrasound: Chronic diffuse liver disease, Doppler criteria for grade I venous restrictive liver disease, splenomegaly. He presented multiple organ failure due to coagulopathy, acute liver failure and kidney injury and was sent to a third-level unit for Molecular Adsorbent Recirculating System (MARS) therapy.

Results

It was classified as grade 3B acute-on-chronic liver failure without being a candidate for transplant. During his hospitalization, MARS therapy was performed on two occasions: single-session hemodialysis, hypertonic solution for cerebral edema, and treatment for hyperammonemia. He was started on carvedilol, vitamin E and lipophilic statin. Without organ failure, creatinine levels normalized, mild transaminasemia persisted and as well as hyperbilirubinemia at the expense of direct bilirubin. Continuing follow-up by external consultation.

Conclusions

The complex interaction between hepatic steatosis, hepatitis A infection and acute-on-chronic liver failure is highlighted, noting the importance of comprehensive evaluation and multidisciplinary management. The increasing prevalence of hepatic steatosis poses additional challenges in the management of hepatitis A, increasing the risk of severe forms of the disease. Timely and specialized treatment are essential to address this complex clinical condition.

Ethical statement: Patient identity is protected. Informed consent 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.