Fulminant hepatic failure due to combined infection with Plasmodium falciparum and hepatitis A virus

Abstract

and acute hepatitis A virus infection can each present with fulminant hepatic failure. Literature on concurrent infections leading to fulminant hepatic failure is scanty. Forty nine years old male, coal mine worker, presented with history of fever followed by yellowish discoloration of eye and urine and irrelevant talk, drowsiness. Patient had Ig M anti HAV antibody positivity. Patient was treated with standard measure for fulminant hepatic failure. Patient did not improve. Patient had disproportionate anemia, mild elevation of transaminases and mild derangement of prothrombin time. Rapid malarial antigen test was positive for plasmodium falciparum though peripheral blood smear was non-contributory. Antimalarial treatment was started and patient improved. FHF related to malaria and hepatitis A virus infection has similar clinical presentation. Patient with malaria simulating FHF may have significant anemia, mild derangement of prothrombin time compared to viral FHF. This case teaches us that co-infections with two hepatotropic pathogens require immediate attention with early intervention which may lead to survival of patient.