DISCUSSION
This is an unusual presentation of acute HAV infection causing liver failure and requiring a liver transplant. HAV usually presents as an acute infection ranging from mild to severe disease, does not have a chronic clinical form, and less than 1% can develop liver failure. About a third of patients with acute liver failure secondary to HAV need a transplant, while the other two thirds recover spontaneously (5). Preexisting liver conditions like non-alcoholic and alcoholic liver disease makes individuals more susceptible to develop liver failure. This is consistent with what we observed in our patient, as the possibility of an underlying chronic steatohepatitis (as mentioned in the first biopsy) could not be entirely excluded. Further complicating the situation is the empiric observation that HAV hepatitis can trigger the onset of AIH particularly in susceptible individuals. Finally, recurrent HAV infection after liver transplantation is even rarer and only a handful of cases have been reported in the literature.
REFERENCES
Contributed by Hugo Kaneku, MD and Marta Minervini, MD