Therapeutic Plasma Exchange as Salvage Therapy in Paediatric Fulminant Hepatitis A Complicated by Acute Kidney Injury and Multidrug-Resistant Pneumonia: A Case Report
- 1Internal Medicine, Government Medical College, Surat, Surat, IND
- 2Limb Reconstruction, Nationwide Children's Hospital, Columbus, USA
- 3Pathology, Narendra Modi Medical College, Ahmedabad, IND
Abstract
Although hepatitis A virus infection is mostly self-limited, it can rarely cause acute fulminant liver failure, especially in resource-limited settings where emergency liver transplant is unavailable. We present the case of a 14-year-old girl diagnosed with acute fulminant hepatitis A complicated by severe hepatic encephalopathy (Glasgow Coma Scale (GCS)-2T/10), acute kidney injury (AKI), and ventilator-associated pneumonia (VAP). On admission, the patient required mechanical ventilation and intensive supportive care. Due to rapidly worsening coagulopathy (international normalized ratio (INR): 4.39) and profound hyperammonaemia (391 µmol/L), she underwent three sessions of therapeutic plasma exchange (TPE) alongside targeted broad-spectrum antimicrobial therapy. Marked clinical and metabolic improvement was observed post-TPE, culminating in the full recovery of hepatic and renal function and total resolution of her encephalopathy. She was successfully discharged with normal organ function. This case emphasizes the critical value of early diagnosis and aggressive multidisciplinary management and highlights the effective role of TPE as a temporary metabolic bridge during the critical phase of illness to spontaneous recovery in selected cases of paediatric fulminant hepatic failure (FHF), enabling survival without liver transplantation even amidst severe multiorgan dysfunction.
Related
- Acquired generalized lipodystrophy complicated by fulminant type 1 diabetes mellitus: a case report with review of literature and immunological insights
- Case Report: Fulminant sintilimab-associated myocarditis complicated by complete atrioventricular block and suspected myositis-myasthenia gravis overlap syndrome
- Fulminant Ischemic Colitis With Toxic Megacolon in a Young Man Receiving Testosterone Replacement Therapy Despite Therapeutic Phlebotomy for Hereditary Hemochromatosis: A Case Report
- Role of Hyperbilirubinaemia as a Predictor of Complicated Appendicitis in Paediatric Population
- Paediatric chronic hepatitis C and the global elimination gap: burden and trends from 1990 to 2023 in the Global Burden of Disease Study 2023
BibTeX
@article{patel2026therapeutic,
title = {{Therapeutic Plasma Exchange as Salvage Therapy in Paediatric Fulminant Hepatitis A Complicated by Acute Kidney Injury and Multidrug-Resistant Pneumonia: A Case Report}},
author = {Yatri Patel and Vatsal Goswami and Uttam Gondalia and Rahul Patel and Riya C Nayak},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117146},
url = {https://europepmc.org/article/PMC/PMC13718995},
note = {CC BY},
}
RIS
TY - JOUR
TI - Therapeutic Plasma Exchange as Salvage Therapy in Paediatric Fulminant Hepatitis A Complicated by Acute Kidney Injury and Multidrug-Resistant Pneumonia: A Case Report
AU - Yatri Patel
AU - Vatsal Goswami
AU - Uttam Gondalia
AU - Rahul Patel
AU - Riya C Nayak
PY - 2026
DA - 2026/09/29
JO - Cureus
DO - 10.7759/cureus.117146
UR - https://europepmc.org/article/PMC/PMC13718995
AB - Although hepatitis A virus infection is mostly self-limited, it can rarely cause acute fulminant liver failure, especially in resource-limited settings where emergency liver transplant is unavailable. We present the case of a 14-year-old girl diagnosed with acute fulminant hepatitis A complicated by severe hepatic encephalopathy (Glasgow Coma Scale (GCS)-2T/10), acute kidney injury (AKI), and ventilator-associated pneumonia (VAP). On admission, the patient required mechanical ventilation and intensive supportive care. Due to rapidly worsening coagulopathy (international normalized ratio (INR): 4.39) and profound hyperammonaemia (391 µmol/L), she underwent three sessions of therapeutic plasma exchange (TPE) alongside targeted broad-spectrum antimicrobial therapy. Marked clinical and metabolic improvement was observed post-TPE, culminating in the full recovery of hepatic and renal function and total resolution of her encephalopathy. She was successfully discharged with normal organ function. This case emphasizes the critical value of early diagnosis and aggressive multidisciplinary management and highlights the effective role of TPE as a temporary metabolic bridge during the critical phase of illness to spontaneous recovery in selected cases of paediatric fulminant hepatic failure (FHF), enabling survival without liver transplantation even amidst severe multiorgan dysfunction.
SN - 2168-8184
ER -