title: Severe acute hepatitis A associated with acute pure red cell aplasia.
abstract: A rare case of severe acute hepatitis A complicated by pure red cell aplasia (PRCA) is reported. A 60-year-old man with jaundice and hepatomegaly was diagnosed as having acute hepatitis A by positive IgM anti-hepatitis A antibody (anti-HAV). Severe anemia rapidly developed 3 weeks after admission, and the patient was diagnosed with PRCA by both bone marrow smears and erythrocyte survival study. The anemia was transient and bone marrow recovered within 1 week. However, concomitant with bone marrow recovery, the hepatitis worsened. He became drowsy and disoriented and severe jaundice, ascites, prolonged prothrombin time, increased transaminase levels, and abnormal electroencephalogram (EEG) were exhibited. Plasma exchange transfusion and glucagon-insulin (GI) therapy improved the consciousness level, but bilirubin, transaminase levels, and IgM anti-HAV titer remained high. Intravenous administration of lipophilized prostaglandin E1 (lipo-PGE1) was added to the GI therapy. Bilirubin and transaminase levels were normalized in the 8th week after the initiation of this combination therapy (17 weeks after admission). The combined use of lipo-PGE1 with plasma exchange and GI therapy appeared to be useful for the prolonged severe hepatitis in this patient.
authors.affiliation: Department of Medicine, University of Tsukuba, Ibaraki, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Tomida
authors.forename: Y
authors.initials: Y
authors.lastname: Matsuzaki
authors.forename: M
authors.initials: M
authors.lastname: Nishi
authors.forename: T
authors.initials: T
authors.lastname: Ikegami
authors.forename: T
authors.initials: T
authors.lastname: Chiba
authors.forename: M
authors.initials: M
authors.lastname: Abei
authors.forename: N
authors.initials: N
authors.lastname: Tanaka
authors.forename: T
authors.initials: T
authors.lastname: Osuga
authors.forename: Y
authors.initials: Y
authors.lastname: Sato
authors.forename: T
authors.initials: T
authors.lastname: Abe
mesh_terms: D000208:Acute Disease; D000527:Alprostadil / Q000627:therapeutic use; D001706:Biopsy; D003131:Combined Modality Therapy; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D005934:Glucagon / Q000627:therapeutic use; D006506:Hepatitis A / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D012010:Red-Cell Aplasia, Pure / Q000150:complications* / Q000175:diagnosis
chemical_list: D005765:Gastrointestinal Agents; D007328:Insulin; D005934:Glucagon; D000527:Alprostadil