Fulminant hepatitis A in a patient with severe hyperthyroidism : Rapid recovery from hepatic coma after plasmapheresis and total thyroidectomy

A 62-yr-old Chinese man was transferred to the medical intensive care unit of our university hospital because of hepatic coma and severe hyperthyroidism. The software engineer, who had lived in Germany for 10 yr, had been well until 3 days before admission, when he experienced acute onset of nausea,...

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Bibliographic Details
Published in:The journal of clinical endocrinology and metabolism 2000-05, Vol.85 (5), p.1765-1769
Main Authors: ENGHOFER, M, BADENHOOP, K, ZEUZEM, S, SCHMIDT-MATTHIESEN, A, BETZ, C, ENCKE, A, USADEL, K. H
Format: Article
Language:English
Subjects:
Biological and medical sciences
China - ethnology
Diagnosis, Differential
Endocrinopathies
Follow-Up Studies
Germany
Hepatic Encephalopathy - therapy
Hepatitis A - complications
Hepatitis A - diagnosis
Human viral diseases
Humans
Hyperthyroidism - complications
Hyperthyroidism - diagnosis
Hyperthyroidism - surgery
Infectious diseases
Liver Function Tests
Male
Medical sciences
Middle Aged
Non tumoral diseases. Target tissue resistance. Benign neoplasms
Plasmapheresis
Thyroid Function Tests
Thyroid. Thyroid axis (diseases)
Thyroidectomy
Time Factors
Viral diseases
Viral hepatitis
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Summary:A 62-yr-old Chinese man was transferred to the medical intensive care unit of our university hospital because of hepatic coma and severe hyperthyroidism. The software engineer, who had lived in Germany for 10 yr, had been well until 3 days before admission, when he experienced acute onset of nausea, vomiting, and diarrhea. The next day, he started passing black, tarry stools. Jaundice, low-grade fever, and pronounced malaise developed. Three days after onset of symptoms he was admitted to another hospital, where gastroscopy showed diffuse gastric bleeding due to erosive gastritis. He was treated with ranitidine and metoclopramide iv. The laboratory investigations at admission showed markedly elevated liver enzymes, a prolonged prothrombin time, and decreased serum levels of antithrombin III and total protein. Glucose, electrolytes, blood urea nitrogen, creatinine, creatine phosphokinase, amylase, lipase, uric acid, complete blood count (with the exception of a reduced platelet count), and erythrocyte sedimentation rate were within the normal range. Serologic tests for antibodies against hepatitis A (IgG and IgM) were positive, and the patient showed marked hyperthyroidism.
ISSN:0021-972X
1945-7197
DOI:10.1210/jc.85.5.1765