Hepatitis C virus-associated fulminant hepatic failure

FULMINANT hepatic failure is a dramatic clinical syndrome characterized by massive necrosis of liver cells.(1) It is most often caused by hepatitis A virus and hepatitis B virus (HBV)(2); whether hepatitis C virus (HCV) can cause it is still controversial.(3,4) Among patients with non-A, non-B fulminant hepatitis, antibodies against HCV (anti-HCV) or serum HCV RNA were found in 40 to 60 percent in Japan(5,6) and Taiwan,(7) but in only 2 percent (range, 0 to 12 percent) in Western countries,(8-13) with one exception: a recent study conducted in California reported a prevalence of 60 percent associated with low socioeconomic status and Hispanic ethnicity.(14) Whether these discrepancies reflect geographic differences in the epidemiology of HCV infection or the pathogenicity of the prevalent viral strains is not known. Furthermore, because of the dramatic course of fulminant hepatic failure, in most patients only a single serum sample, often obtained late in the course of the disease, was studied. In this report, we describe a patient with HCV-associated fulminant hepatitis in whom serial studies were done that provided a unique opportunity to establish a temporal association between the acquisition of HCV infection and the development of fulminant hepatitis and to define the clinical, virologic, and histologic profile of fulminant hepatitis C.