A case of hepatic encephalopathy in an young female due to acute hepatitis E followed by complete recovery: A rare case report

Abstract

Hepatic encephalopathy is a fatal complication of both chronic liver disease and acute hepatocellular failure. Usually, in such cases, the disease has a rapid progression and fatal prognosis. We report a young female who was admitted in Medical College, Kolkata, India, in 2016 with clinical and biochemical evidence of encephalopathy and coagulopathy (hyperacute liver failure) following an acute hepatitis-like illness. Blood for hepatitis B surface antigen, anti-hepatitis C virus, IgM-hepatitis A virus, and IgM anti-Leptospira all were negative, but anti-hepatitis E virus (HEV) IgM came out to be positive (titer of 6.8 U/ml; whereas 1.1 – positive). IgM anti-HEV was tested using commercially available ELISA kits (Genelabs) using sandwich ELISA technique. The patient was aggressively managed with intravenous fluid, antibiotics, lactulose syrup and enema, and transfusion of fresh frozen plasma along with strict monitoring for other vital organ damage. Symptoms of encephalopathy completely reversed within 5–6 days, and prothrombin time and liver enzymes were normalized gradually. Although acute liver failure with high mortality is common in acute hepatitis E in pregnancy, here, in our case, it happened to a young nonpregnant female followed by complete recovery.

Keywords

• Encephalopathy
• hepatitis E
• prothrombin time