Spontaneous Recovery from Hepatitis A-Induced Acute Liver Failure in a Child: A Rare Case Report from Hargeisa Group Hospital, Somaliland.

BACKGROUND: Hepatitis A-induced acute liver failure (ALF) is a rare but leading cause of pediatric ALF in developing countries. ALF is defined as severe acute liver injury with coagulopathy and hepatic encephalopathy occurring within 26 weeks of symptom onset in patients without pre-existing chronic liver disease. It carries high mortality, accounting for approximately 8% of liver transplants worldwide, with reported survival rates ranging from 30-60% in the absence of transplantation. Fewer than 1% of patients with hepatitis A progress to ALF.

CASE PRESENTATION: A 5-year-old girl from Wajaale, Somaliland, presented with fever, jaundice, and altered consciousness. She also developed hematemesis secondary to severe coagulopathy (INR 4.0), with no evidence of esophageal varices. Laboratory evaluation revealed markedly elevated transaminases and hyperbilirubinemia. HAV IgM was positive. Supportive therapy with lactulose, neomycin, vitamin K, and nutritional support resulted in full clinical and biochemical recovery without the need for liver transplantation.

CONCLUSION: This case demonstrates that spontaneous recovery from HAV-induced ALF is possible with timely supportive care, even in resource-limited settings where monitoring and grading of encephalopathy are vital. It underscores the public health importance of strengthening supportive care protocols and implementing universal HAV vaccination to prevent these high-mortality emergencies.