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Volume 7, Issue 7 (Suppl)
J Gastrointest Dig Syst
ISSN: 2161-069X JGDS, an open access journal
Gastroenterologists 2017
December 14-15, 2017
December 14-15, 2017 Dubai, UAE
11
th
World
Gastroenterologists Summit
A 24-year old female with indeterminate hyperacute liver failure: A case report
Maria Elizabeth Ching and Marie Antoinette Lontok
St. Luke’s Medical Center, Philippines
A
cute liver failure (ALF) in the young is rare, yielding limited known data in its pathophysiology and management. ALF
refers to sudden massive hepatic necrosis with encephalopathy and impaired synthetic function without pre-existing
cirrhosis. 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.
Interval between jaundice and encephalopathy was hyperacute (<7 days). Laboratory findings showed hyper-bilirubinemia,
transaminitis, elevated alkaline phosphatase, impaired coagulation hyper-ammonemia 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,
ceruloplasmin, strepA throat screen test, malarial smear and leptospiral IgM were all unremarkable. Medical and supportive
treatments were promptly provided. Orthotopic liver transplantation (OLT) was contemplated, however, cerebral edema and
hemorrhage ensued on day 5 leading to demise. 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. We report a case of indeterminate hyper-acute liver failure in a healthy 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.
mariaelizabethching@yahoo.comJ Gastrointest Dig Syst 2017, 7:7 (Suppl)
DOI: 10.4172/2161-069X-C1-062