Subacute fulminant hepatic failure with intermittent fever.
BACKGROUND
Viral hepatitis B accounts for over 80% of acute hepatic failures in China and the patients die mainly of its complications. A patient with hepatic failure and fever is not uncommon, whereas repeated fever is rare.


METHODS
A 32-year-old female was diagnosed with subacute hepatic failure and hepatitis B viral infection because of hyperbilirubinemia, coagulopathy, hepatic encephalopathy, serum anti-HBs-positive without hepatitis B vaccination, and typical intrahepatic pathological features of chronic hepatitis B. Plasma exchange was administered twice and she awoke with hyperbilirubinemia and discontinuous fever.


RESULTS
Urethritis was confirmed and medication-induced fever and/or spontaneous bacterial peritonitis (Gram-negative bacillus infection) was suspected. The patient was treated with antibiotics, steroids and a Chinese herbal medicine, matrine, for three months and she recovered.


CONCLUSIONS
The survival rate of patients with hepatic failure might be improved with comprehensive supporting measures and appropriate, timely management of complications.
Chen
Cong-Xin
CX
Department of Infectious Diseases, 105th Hospital, Hefei 230031, China. congxinc@mail.hf.ah.cn
Liu
Bo
B
Hu
Yong
Y
Johnson
Joyce E
JE
Tang
Yi-Wei
YW
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000821:virology; D004365:Drugs, Chinese Herbal; D005260:Female; D005334:Fever / Q000628:therapy / Q000821:virology*; D006501:Hepatic Encephalopathy / Q000821:virology; D006509:Hepatitis B / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D006932:Hyperbilirubinemia / Q000821:virology; D017114:Liver Failure, Acute / Q000628:therapy / Q000821:virology*; D010951:Plasma Exchange; D012008:Recurrence; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D014526:Urethritis / Q000175:diagnosis / Q000628:therapy / Q000821:virology*
D000900:Anti-Bacterial Agents; D004365:Drugs, Chinese Herbal; D013256:Steroids