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Fulminant Hepatitis

By

Sonal Kumar

, MD, MPH, Weill Cornell Medical College

Last full review/revision Dec 2020| Content last modified Dec 2020
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Fulminant hepatitis is a rare syndrome of rapid (usually within days or weeks), massive necrosis of liver parenchyma and a decrease in liver size (acute yellow atrophy); it usually occurs after infection with certain hepatitis viruses, alcoholic hepatitis, or drug-induced liver injury (DILI).

Hepatitis B virus is sometimes responsible for fulminant hepatitis, and up to 50% of cases of fulminant hepatitis B involve hepatitis D virus coinfection. Fulminant hepatitis with hepatitis A virus is rare but may be more likely in people with preexisting liver disorders. Occasionally, hepatitis E virus causes fulminant hepatitis. The role of hepatitis C virus remains uncertain.

Alcoholic hepatitis may cause fulminant liver failure, but most patients have a long history of heavy drinking and so probably have underlying chronic liver disease.

Symptoms and Signs of Fulminant Hepatitis

Increasing prothrombin time (PT) or international normalized ratio (INR), portosystemic encephalopathy, and particularly renal failure are ominous.

Diagnosis of Fulminant Hepatitis

  • Clinical evaluation

  • Liver tests

  • PT/INR measurement

Fulminant hepatitis should be suspected if

  • Patients are acutely ill with new-onset jaundice, rapid changes in mental status, or unexplained bleeding.

  • Patients with known liver disease rapidly deteriorate.

Laboratory tests to confirm the diagnosis of fulminant hepatitis include liver tests (eg, aminotransferases, alkaline phosphatase) and other tests to evaluate liver function (prothrombin time/international normalized ratio [PT/INR], bilirubin, albumin).

The serum acetaminophen level should be measured in all patients if acetaminophen toxicity is suspected.

Treatment of Fulminant Hepatitis

  • Oral nucleoside or nucleotide analogs

  • Sometimes N-acetylcysteine

  • Liver transplantation

Meticulous medical care, usually in an intensive care unit, and aggressive treatment of complications improve the outcome of patients with fulminant hepatitis.

Patients who survive usually recover fully.

Drugs Mentioned In This Article

Drug Name Select Trade
ACETADOTE
TYLENOL
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Hepatitis E
There are 4 genotypes of the hepatitis E virus (HEV), and each of these genotypes can cause acute viral hepatitis. HEV was not originally thought to cause chronic hepatitis; however, reports have documented chronic hepatitis exclusively in immunocompromised patients. Which of the following genotypes is responsible for chronic hepatitis in these patients? 
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