Post-infantile giant cell hepatitis, management, six-year follow-up and re-transplantation, a successful case report during the pandemic

Abstract

Introduction and Objectives: HCG is a relatively common histological finding in newborns. In children, it presents with cholestasis, hyperbilirubinemia and inflammation; in the adult population, it remains poorly defined, with only 100 cases published in the literature during the last three decades. Materials and methods: We present the case of a 20-year-old female patient with a history of herbal medicine and valproate, debuting six years ago with pain in the right hypochondrium, jaundice and fever with progression to liver failure, hepatotropic virus infections and autoimmunity were ruled out. Start liver transplant protocol with incompatible ABO organ, with induction with rituximab, immunoglobulin and basiliximab with post-surgical complications with resolved hemoperitoneum and pulmonary hemorrhage, with subsequent discharge and histopathological report of giant cell hepatitis explant, continuing immunosuppression for six years until readmission due to pruritus with liver biopsy that reported acute cellular rejection and ERCP with choledocho-choledochoanastomosis stenosis with endoscopic rehabilitation, with subsequent biochemical deterioration, starting basiliximab, steroids, plasma exchanges and MARS without improvement, subsequent ABO compatible retransplantation without complications. Currently no rejection data. Discussion: HCGPI is a progressive, often fatal, disease process with a 50% survival rate without liver transplantation. The high mortality rate is caused by liver failure or sepsis as a result of immunosuppressive therapy. Conclusion: HCGPI in our patient manifested acutely with rapid evolution toward liver failure. The use of valproate and herbal medicine were factors. Thanks to the possibility of using MARS as a bridge for the transplant, the result was optimal. Funding: The resources used in this study were from the hospital without any additional financing Declaration of interest: The authors declare no potential conflicts of interest.