Hepatitis C virus-associated fulminant hepatic failure

Fulminant hepatic failure is characterized by encephalopathy occurring within a short duration after the first symptoms of liver disease. The condition is most often caused by infection with hepatitis A and hepatitis B viruses. It has not yet been conclusively demonstrated that acute hepatitis C virus (HCV) infection can cause fulminant hepatic failure. In this brief report, the authors describe a patient who developed fulminant hepatic failure several weeks after receiving blood transfusions while undergoing coronary artery bypass grafting surgery. Prior to transfusion, antibodies against HCV were not present in the patient's serum and HCV RNA could not be detected by the polymerase chain reaction. Five weeks after transfusion, when the serum alanine aminotransferase activity was greater than 3000 U/L and fulminant hepatic failure developed, HCV RNA was detected in serum and remained detectable until the patient's death 11 days later. Anti-HCV antibodies were detected in serum one day prior to death. HCV antigen was also present in the liver at autopsy. Hepatitis G and hepatitis B virus RNA and IgM antibodies against hepatitis A virus were also not detected in serum samples. Although only a single case report, this study strongly suggests that acute HCV infection can cause fulminant hepatic failure.

Authors: Farci, P., Alter, H. J., Shimoda, A., Govindarajan S., Cheung, L. C., Melpolder, J. C., Sacher, R. A., Shih, J. W., and Purcell, R. H.
Journal: New England Journal of Medicine. 335:631-634. 1996

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