A case of fulminant hepatitis B followed by non A- non B posttransfusion hepatitis

A 21-year-old female survived fulminant hepatitis B by extensive treatments including chacoal hemoperfusion. However, she suffered a reelevation of SGPT with jaundice during the recovery stage (44 days from the onset of the grade 4 coma) from the fulminant episode. Both serum immune complex and serum HBs antigen-antibody immune complex were detected during the grade 4 coma of fulminant hepatitis, but the only former was positive in the second episode. Liver biopsy specimens obtained on the 8th day from the onset of the grade 4 coma revealed a conspicuous and diffuse hydropic swelling of hepatocytes which was not associated with necrosis of parenchymal cells. On the contrary, submmasive loss of parenchymal cells with marked inflammatory response was observed in the liver biopsy specimens in the acute stage of the second episode. There was no change of the antibody titers of HA virus, EB virus, Herpes Simplex virus and Cytomegarovirus before and after the second episode. Since this patient received transfusion (6 units) during the fulminant episode, the second elevation of SGPT was considered to be non A- non B hepatitis of which the incubation period was almost 40 days.