title: Fatal fulminant hepatitis caused by infection with subgenotype A1 hepatitis B virus with C1766T/T1768A core promoter mutations.
abstract: Adults initially infected with the hepatitis B virus develop various types of hepatitis ranging from asymptomatic to fulminant, and the clinical course of infection is influenced by a variety of host and viral factors. The viral risk factors associated with fulminant hepatitis reportedly include subgenotype B1, negative HBe antigen, and mutations in the precore and core promoter regions. Here, we present a case of fatal fulminant hepatitis caused by infection with subgenotype A1 hepatitis B virus with C1766T/T1768A double mutations in the core promoter region. A 53-year-old man was hospitalized with acute hepatitis B. Immediately after admission, entecavir was administered. However, his condition deteriorated, developing into fulminant hepatitis 2 days later. Artificial extracorporeal liver support therapy with plasma exchange (PE) and hemodiafiltration (HDF) were started. At one time point, the severity of hepatic encephalopathy decreased from grade II to grade 0, and the prothrombin time also improved, increasing from 11 to 73 %. However, the total bilirubin levels remained at or above 20 mg/dL and blood creatinine levels gradually increased. HDF was restarted, and therapies such as bilirubin adsorption and PE were administered. However, neither hepatic nor renal failure was alleviated, and the patient died 78 days after admission.
authors.affiliation: Division of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-machi, Takasaki, Gunma, 370-0829, Japan. fwnx6146@yahoo.co.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Hoshino
authors.affiliation: Department of Internal Medicine, Sanshikai Kusunoki Hospital, Fujioka, Gunma, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takagi
authors.affiliation: Division of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-machi, Takasaki, Gunma, 370-0829, Japan.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Division of Gastroenterology, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-machi, Takasaki, Gunma, 370-0829, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Naganuma
authors.affiliation: Division of Gastroenterology and Hepatology, Gunma University School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Sato
authors.affiliation: Division of Gastroenterology and Hepatology, Gunma University School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Kakizaki
authors.affiliation: Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nishizawa
authors.affiliation: Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Okamoto
authors.affiliation: Division of Gastroenterology and Hepatology, Gunma University School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yamada
mesh_terms: D017809:Fatal Outcome; D006501:Hepatic Encephalopathy / Q000000981:diagnostic imaging / Q000821:virology*; D006509:Hepatitis B / Q000000981:diagnostic imaging / Q000821:virology*; D006515:Hepatitis B virus / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011401:Promoter Regions, Genetic / Q000235:genetics*; D051437:Renal Insufficiency / Q000821:virology; D014057:Tomography, X-Ray Computed
keywords: C1766T/T1768A mutations; Fulminant hepatitis; Hepatitis B virus; Renal failure; Subgenotype A1