Fulminant hepatitis A in a robust adult: a case report of acute liver failure requiring urgent living donor liver transplantation.

BACKGROUND

Hepatitis A virus (HAV) infection is generally a self‑limited disease; however, in adults it can rarely progress to acute liver failure (ALF), a rapidly evolving and potentially fatal condition. Although HAV‑related ALF occurs in <1% of the general adult population, the incidence may rise to about 10% in hospitalized or severe cases, with reported outcomes of 55% recovered, 31% transplanted, and 14% died. Early recognition, rapid prognostic assessment, and timely referral to a transplant center are essential because deterioration can occur abruptly and unpredictably.

CASE DESCRIPTION: A previously healthy 34‑year‑old man presented with fever, severe abdominal pain, vomiting, diarrhea, and dizziness shortly after returning from travel. He reported frequent consumption of street‑vended food, a potential risk factor for HAV exposure. On examination, he was jaundiced and acutely ill, and laboratory evaluation revealed profound hepatocellular injury [aspartate aminotransferase (AST) 4,520 U/L; alanine aminotransferase (ALT) 3,880 U/L], marked hyperbilirubinemia, lactic acidosis, acute kidney injury, thrombocytopenia, and elevated ammonia. Serology confirmed acute HAV infection. Despite aggressive intensive care unit (ICU) management, he deteriorated rapidly, developing septic shock and multiple organ dysfunction, including worsening encephalopathy and coagulopathy. Based on poor prognostic indicators, he was urgently transferred to a transplant center and underwent successful living donor liver transplantation (LDLT) within 96 hours of presentation. His postoperative recovery was remarkable, with rapid normalization of graft function and discharge just 7 days after surgery.

CONCLUSIONS

This case highlights that HAV infection in adults, though uncommon, can progress swiftly to fulminant liver failure requiring urgent transplantation. Prompt diagnosis, early transfer to a specialized transplant center, and timely LDLT can lead to excellent outcomes, as demonstrated by this patient's rapid recovery.