What is the meaning of fulminant hepatitis B?

Author: Prof. Jean-François Dufour

Updated: 10 / 2007


Fulminant hepatic failure is defined by altered mental status (encephalopathy) and coagulopathy (factor V less than 50%) developing within 8 weeks in a patient without previous liver disease. Acute hepatitis B infection leads to acute liver failure in less than 1% of patients infected with HBV. The pathogenesis is a massive immune reaction against infected hepatocytes, which results in viral clearance. The viremia might be negative at the time of liver failure. A finding of IgM antibodies against HBc antigen helps determine the diagnosis. A superinfection with hepatitis D virus in a patient already infected with HBV also should be considered. In recent years, hepatitis B has become an infrequent cause of acute liver failure (<10% of total cases). Care must be taken to avoid reactivating HBV in immunosuppressed patients, such as those receiving steroids, TNF-alpha inhibitors, or other similar drugs. These patients are at risk of developing acute liver failure when the immunosuppressants are decreased. This situation is preventable with the treatment of a nucleoside analogue such as lamivudine. Patients with fulminant hepatitis B should be referred as sson as possible to a transplant center. The decision to list patients is based on a combination of criteria including factor V for the Clichy criteria, age, bilirubin, PT and time from jaundice to encephalopathy.


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