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  • Acute hepatitis A with haemophagocytic lymphohistiocytosis: G-6PD deficiency-induced haemolytic anaemia and bile cast nephropathy

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Gastroenterology
Acute hepatitis A with haemophagocytic lymphohistiocytosis: G-6PD deficiency-induced haemolytic anaemia and bile cast nephropathy
  1. Biju Illolil Kuniyil1,
  2. Sameer Sakkeer Hussain2,
  3. Gouri Suresh2 and
  4. Semeera Thoufeeq3
  1. 1 Gastroenterology, Baby Memorial Hospital, Kozhikode, Kerala, India
  2. 2 Medical Gastroenterology, Baby Memorial Hospital, Calicut, Kerala, India
  3. 3 Internal Medicine, Baby Memorial Hospital, Calicut, Kerala, India
  1. Correspondence to Dr Biju Illolil Kuniyil; ikbiju72{at}yahoo.com

Abstract

Hepatitis A virus (HAV) infection typically presents as a self-limiting illness but it can cause debilitating symptoms and rarely fulminant hepatitis (acute liver failure), which is often fatal. WHO estimates that in 2016, 7134 persons died from hepatitis A worldwide (accounting for 0.5% of the mortality due to viral hepatitis). Fulminant hepatic failure is observed in less than 1% of cases of acute viral hepatitis A. Haemophagocytic lymphohistiocytosis (HLH) is a clinical syndrome of excessive inflammation and tissue destruction owing to abnormal immune activation. Acquired HLH due to viral infections (also known as virus-associated haemophagocytic syndrome) is most commonly associated with Epstein-Barr virus and cytomegalovirus (CMV). HAV-associated HLH has been rarely reported. Haemolysis of mild to moderate degree is not unheard of in cases of hepatitis A, which is often immune-mediated. Here, we present the case of a man in his 30s, with G6PD deficiency unmasked by acute viral hepatitis A, which later on progressed to hyperacute liver failure, HLH and renal failure.

  • Infections
  • Gastrointestinal system
  • Hepatitis other
  • Immunology
  • Jaundice

https://doi.org/10.1136/bcr-2024-260785

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: BIK, SSH, GS and ST. The following authors gave final approval of the manuscript: BIK, SSH, GS and ST.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.