A case of acute fulminant hepatitis B who showed deep coma 15 hours after onset and died

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  • IZUMI Yuko
    Department of Gastroenterology, Osaka University Graduate School of Medicine
  • HIRAMATSU Naoki
    Department of Gastroenterology, Osaka University Graduate School of Medicine
  • ITOSE Ichiyo
    Department of Gastroenterology, Osaka University Graduate School of Medicine
  • INOUE Takahiro
    Department of Gastroenterology, Osaka University Graduate School of Medicine
  • EGAWA Satoshi
    Department of Gastroenterology, Osaka University Graduate School of Medicine
  • NISHIDA Tsutomu
    Department of Gastroenterology, Osaka University Graduate School of Medicine
  • KAKIUCHI Yoshimi
    Department of Gastroenterology, Osaka University Graduate School of Medicine
  • TOYAMA Takashi
    Department of Gastroenterology, Osaka University Graduate School of Medicine
  • NAKANISHI Fumihiko
    Department of Gastroenterology, Osaka University Graduate School of Medicine
  • IGURA Takumi
    Department of Gastroenterology, Osaka University Graduate School of Medicine
  • TAMURA Shinji
    Department of Gastroenterology, Osaka University Graduate School of Medicine
  • TSUJII Masahiko
    Department of Gastroenterology, Osaka University Graduate School of Medicine
  • TSUJI Shingo
    Department of Gastroenterology, Osaka University Graduate School of Medicine
  • KANTO Tatsuya
    Department of Gastroenterology, Osaka University Graduate School of Medicine
  • TAKEHARA Tetsuo
    Department of Gastroenterology, Osaka University Graduate School of Medicine
  • KASAHARA Akinori
    Department of Gastroenterology, Osaka University Graduate School of Medicine
  • SASAKI Yutaka
    First Department of Internal Medicine, Kumamoto University School of Medicine
  • FUKUDA Kazuto
    Department of Gastroenterology, Ikeda City Hospital
  • IMAI Yasuharu
    Department of Gastroenterology, Ikeda City Hospital
  • HAYASHI Norio
    Department of Gastroenterology, Osaka University Graduate School of Medicine

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Other Title
  • ＨＢＶ初感染により劇症化１５時間後に深昏睡となり死亡した急性型劇症肝炎の１例

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症例は58歳女性. 全身倦怠感, 発熱にて近医受診したところ, 総ビリルビン6.4mg/dl, AST 8327U/l, ALT 10879U/l, プロトロンビン時間7.5%と著明な肝機能低下を認めたため, 当院入院となった. 発症3日後の入院時には脳症II°となり, 劇症肝炎急性型と診断し, 直ちに血漿交換などの集中治療を開始したが, 肝炎劇症化から15時間後には脳圧の上昇とともに, 深昏睡となった. 2日後, 生体肝移植術を施行. 術後, 肝機能の増悪はなかったが, 意識レベル低下, 脳圧亢進は改善せず, 感染症を併発して入院8日目に死亡した. 剖検にて, 脳に出血や梗塞による組織変化は認めず, 脳圧亢進は肝性脳症によるものと考えられた. また, 本症例の劇症肝炎の原因はB型肝炎ウイルス (HBV) 感染であった. HBV genotype Bで, precore 領域, corepromoter 領域の遺伝子配列はともに変異型であった. 劇症肝炎発症の極めて早期に, HBs抗原陰性, HBs抗体強陽性となり, その後のIgM HBc抗体価3.2 (cut off index), IgG HBc抗体57.6% (200倍希釈) の結果から, HBV初感染による劇症肝炎と診断しえた. 比較的予後良好とされる急性型劇症肝炎において, HBV初感染による電撃型ともいえる劇症肝炎を経験した. HBV初感染による劇症肝炎例では, 本症例のように急速な転帰をとる症例があり, 肝移植を念頭に入れたより迅速な対応が必要であるものと考えられた.

Journal

  • Kanzo

    Kanzo 45 (2), 109-115, 2004

    The Japan Society of Hepatology

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