title: Massive Hemolysis Causing Renal Failure in Acute Hepatitis E Infection.
abstract: Acute viral hepatitis is usually a self-limiting illness. However, it can lead to complications that can be life-threatening, such as acute liver failure. Glucose 6 phosphate dehydrogenase (G6PD) deficiency in the setting of acute viral hepatitis can lead to a massive hemolysis, manifesting as acute kidney injury and markedly raised bilirubin levels; although cases are rare. Here, we report such a case. The patient had a viral hepatitis E infection and presented with kidney injury requiring dialysis. Examination showed very high mixed hyperbilirubinemia due to massive intravascular hemolysis. The patient experienced a long, protracted course of illness, requiring renal replacement therapy with other supportive management, which led to improvement over a period of four weeks. This case highlights the importance of recognizing associated hemolysis in a patient with viral hepatitis who presents with very high bilirubin levels or associated kidney injury. Such patients will require aggressive supportive care with prompt fluid and electrolyte management.
authors.affiliation: Department of Internal Medicine, PGIMER, Chandigarh, India.
authors.forename: Pragya
authors.initials: P
authors.lastname: Karki
authors.affiliation: Department of Gastroenterology, PGIMER, Chandigarh, India.
authors.forename: Sarthak
authors.initials: S
authors.lastname: Malik
authors.affiliation: Department of Gastroenterology, PGIMER, Chandigarh, India.
authors.forename: Bipadabhanjan
authors.initials: B
authors.lastname: Mallick
authors.affiliation: Department of Gastroenterology, PGIMER, Chandigarh, India.
authors.forename: Vishal
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology, PGIMER, Chandigarh, India.
authors.forename: Surinder S
authors.initials: SS
authors.lastname: Rana
keywords: Anemia; G6PD deficiency; Hemoglobinuria; Hemolysis; Hepatitis E virus