Fares Kasem, DO, Anne Crowner, MD, Ashutosh Barve, MD, PhD University of Louisville, Louisville, KY Introduction: We present a rare case of acute liver failure secondary to acute Hep C infection in a young female that was cured by Direct-Acting Antivirals (DAA)
Case Description/
Methods: A 21 y.o. woman with a hx of polysubstance use was brought to the ED for AMS and was found to have elevated LFTs. She was suspected to have DILI and started on IV NAC. Her UDS was positive for amphetamines, cocaine, and fentanyl. Mental status changes were initially attributed to her substance use. Unfortunately, her condition continued to worsen and her AST/ALT increased to 7389/5360. She also developed a profound coagulopathy with an INR of 11.14. At that point, she was diagnosed with ALF, and CRRT/PLEX were initiated in an alternating sequence. Despite this treatment, she did not improve, and her INR spiked to 12.19 between PLEX/CRRT sessions. Meanwhile, her HCV PCR showed a VL of 69.9 M IU/mL with a nonreactive HCV antibody, indicating acute Hep C infection, which was suspected to be the cause of her ALF. Treatment with Sofosbuvir/Velpatasvir was initiated. The VL decreased to 0.7 M IU/mL 5 days after DAA initiation. Her INR started to plateau between PLEX/CRRT sessions, and it dropped below 2 after 6 days of treatment with DAA. Notably, her AFP, which was 5.9 before initiation of DAA, rose to 1096 in 5 days, indicating robust liver regeneration. She eventually made full liver function recovery. She showed anti-HCV seroconversion two weeks after initial testing. Her mental status did not recover initially in spite of multiple CT heads showing no cerebral edema. LP revealed positive HSV1 PCR in the CSF. Of note, her initial liver disease work up had shown negative blood HSV1 and 2 PCR and hence her liver disease was not thought to be due to HSV. The pt had a prolonged ICU stay but made a full recovery and was discharged from the hospital after an 80-day hospitalization Discussion: ALF due to HCV infection is extremely rare, with only a few cases reported in the literature. While we initially suspected DILI as the culprit, she did not improve with IV NAC, and her INR continued to spike between PLEX sessions. Initiation of Hep C treatment with DAA resulted in full recovery. Literature review revealed one case of Hep C related ALF in the post-liver transplant setting that was cured with prompt initiation of DAA. A systematic review reports 3 other cases of Hep C-associated ALF prior to DAAs availability. This case illustrates that full recovery can be achieved with prompt DAA initiation in cases of ALF secondary to Hep C
Disclosures: Fares Kasem indicated no relevant financial relationships. Anne Crowner indicated no relevant financial relationships. Ashutosh Barve indicated no relevant financial relationships.
Fares Kasem, DO, Anne Crowner, MD, Ashutosh Barve, MD, PhD. P1835 - A Case of Acute Liver Failure Due to Hepatitis C Rescued by Direct-Acting Antivirals, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
