Hepatitis B Virus Reactivation Superimposed Hepatitis A Co-Infection Leading to Acute on Chronic Liver Failure: A Case Report and Literature Review.

Acute-on-chronic liver failure (ACLF) is a severe condition with an incidence rate of 5.7 cases per 1,000 person-years. A primary trigger for ACLF is hepatitis B reactivation, which is responsible for 40-60% of cases. Co-infection with hepatitis A can also contribute to its occurrence. This study presents the case of a 58-year-old male patient with a history of hepatitis B virus (HBV)-related cirrhosis, presenting with symptoms including confusion, disorientation, worsening jaundice, abdominal discomfort, nausea, vomiting, loss of appetite, malaise, muscle pain, and fever. Despite regular treatment for HBV, the patient's condition deteriorated over 14 days. He had no history of hypertension, diabetes, autoimmune diseases, alcohol consumption, or smoking. On examination, the patient exhibited grade 2 hepatic encephalopathy, severe jaundice, ascites, and lower limb edema. Laboratory results revealed elevated liver enzymes, increased bilirubin levels, and decreased albumin. Subsequent testing confirmed acute hepatitis A infection and a significant hepatitis B viral load. The report highlights that reactivation of Chronic Hepatitis B, accompanied by co-infection with hepatitis A, played a critical role in inducing inflammation and worsening the ACLF condition.