A 53 year-old male patient with positive IgM HA-antibody who was successfully treated after being diagnosed as having fulminant hepatitis A

We successfully treated a 53 year-old male patient who was positive for IgM HA-antibody. The diagnosis was fulminant hepatitis A. This patient had been admitted in a III-stage coma after having influenza-like symptoms and an elevation of transaminases and bilirubin. An intensive treatment regimen including plasma exchange, THE and lactulose was successful in reversing the comatose state to normal levels 7 days after admission. This patient still had positive IgM HAantibody 50 days after onset of the disease. Histological examination 30 days after admission suggested hepatic fibrosis. The prognosis of fulminant hepatitis is generally very poor in aged patients. In addition to the present case, we have treated 4 other patients aged 50 year-old or greater with fulminant hepatitis A. Of the 5 treated, 4 have survived. Fulminant hepatitis A thus appears to have a better prognosis than the other types of fulminant hepatitis. This paper describes this specific case with a bibliographical consideration of related problems.