Acut liver failure of unknown origin

Acute liver failure (ALF) is a rare, often life-threatening syndrome. The severe progressive liver function damage may develop to encephalopathy, coagulopathy and jaundice. Other complications include cerebral oedema, sepsis, and multiple organ failure. The most two frequent causes are paracetamol and Hepatitis A and B, however hepatotoxic drugs, toxins, other viral infections, metabolic or autoimmune diseases, narcotics, herbal drugs are also implicated. In 20% of the cases etiology remains unknown.

Study case: A 23 year old female, with no past history of liver disease. Recently she drank mallow tea as slimming diet. She denied consumption of narcotics and hepatotoxic medications. She was admitted to our emergency department with 3 day fever, nausea, and frequent vomiting. At the time of admission we noticed jaundice, conjunctival suffusion, and slightly enlarged liver. She was comprehensive. Lab: AST: 9780, ALT: 10960, AP: 640, total bi: 124, conj. bi: 66, blood sugar: 2.4, INR: 8.56, creatinine: 286

The viral serologies were negative. The abdominal ultrasound didn't reveal abnormalities. 16 hours after her admission the patient was transported to ICU, because of deterioration of mental status, and significant acidosis. She was booked to transplantation list. Despite the complex intensive treatment her condition rapidly worsened and she died 36 hours after admission. Autopsy noticed a complete liver structure damage. Panlobular necrosis was detected by histology.

Conclusions: In our case the ALF developed probably due to a toxin exposure. However during the very short time no more detailed diagnostics were possible, so the etiology of the dramatic disease remained unknown. Acute liver transplantation was unavailable during the limited time for activities.