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Volume 09 Journal of Gastrointestinal & Digestive System
ISSN: 2161-069X Gastro Congress 2019
July 08-09, 2019
July 08-09, 2019 | Zurich, Switzerland
14th Euro-Global Gastroenterology Conference
A 24-year old female with indeterminate hyperacute liver failure: A case report
Maria Elizabeth C Ching and Marie Antoinette Lontok
St. Luke’s Medical Center, Philippines
Introduction: Acute Liver Failure (ALF) refers to sudden massive hepatic necrosis with encephalopathy and
impaired synthetic function without pre-existing cirrhosis. Chronicity is based on interval between jaundice and
encephalopathy onset as hyperacute (<7 d), acute (7-28 d) and subacute (4-26 wks.).
Case Description: A previously healthy 24-year old female with a history of lacrimal gland tumor on chronic oral
prednisone (40mg) for a year was admitted for acute decreased sensorium, generalized jaundice, tea-colored urine,
anorexia and undocumented fever.
Results: Laboratory findings showed hyperbilirubinemia (total bilirubin 13.26, direct bilirubin 10.68,
indirect bilirubin 2.58), transaminitis (ALT 5507, AST 3549), elevated alkaline phosphatase (195), impaired
coagulation hyperammonemia and normal platelets. Extensive work-up including hepatitis panel, paracetamol,
methamphetamine, cannabinoids, benzodiazepene, barbiturates, cocaine, opiates, phenylcyclidine, cytomegalovirus
IgM, EBV, HSV1, HSV2, C3, anti-Sm and anti-mitochondrial antibody, LKM1, cerulopalsmin, strepA throat screen
test, malarial smear and leptospiral IgMwere all unremarkable. Whole abdominal ultrasound revealed unremarkable
liver, biliary tree and pancreas, with splenomegaly 13 x 14.5cm. Medical and supportive treatment was promptly
provided. Orthotopic liver transplantation (OLT) was contemplated, however, cerebral edema and hemorrhage
ensued on Day 5 leading to demise.
Discussion: Etiology varies widely among toxic, viral, metabolic and vascular insults. There are rare reports of ALF
with repeated steroid administration. Management consisting of intensive care should be initiated depending on
the etiology and chronicity of ALF. OLT has emerged as the only therapeutic intervention with proven benefit for
patients with advanced ALF.
Conclusion: Management of ALF is challenging due to rapid progression of disease and frequently poor prognosis.
We report a case of indeterminate hyperacute liver failure in a healthy young female. Despite extensive work-up and
prompt intensive medical management, rapid clinical deterioration ensued. History of chronic steroid use might be
a precipitant, as supported by few case reports.
J Gastrointest Dig Syst 2019, Volume 09