Journal of Gastrointestinal & Digestive System
Open Access

Abstract

Acute 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 hyperbilirubinemia, transaminitis, elevated alkaline phosphatase, 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 IgM were all unremarkable. Medical and supportive treatment 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 hyperacute 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.

Biography

Maria Elizabeth Ching graduated from the national university, University of the Philippines,  BS Biology (magna cum laude) and Doctor of Medicine. Consistently inclined in the field of research, she presented her thesis dissertation on Genetically Modified Line of Tomato in Asian Vegetable Research and Development Center,Taiwan, and the study Computational Modeling of H275Y and N295S mutations reveals novel interactions between influenza neuraminidase and oseltamivir in the 22nd European Students’ Conference, Charité Universitätsmedizin, Berlin, Germany. She is now a third-year internal medicine resident, and currently the Residents’ Research Head in the Department of Medicine of St Luke’s Medical center, Global City