A 36-year-old woman with term pregnancy developed jaundice, with bilirubin of 7.8 mg/dl, enzymes (FA 1027; GOT 1002; GPT 747), prothrombin 73% and normal abdominal ultrasound.
Two days later she had vaginal delivery.
One month later, total bilirubin was 15.3 mg/dl, prothrombin was 11%, and AF was 364, AST and ALT were decreased.
Abdominal pain, vomiting and impaired consciousness were associated.
He was admitted with negative markers of hepatitis B-C and IgM virus A.
Brain tomography (CT) was normal.
He was in coma, reactive equal pupils, ocular vagabond, living osteotendinous reflexes, indifferent plantar.
Hypotensive seizure/40), tachycardic (130x'), polypneic (40x'), with poor distal perfusion.
He was diagnosed with fulminant liver damage, sepsis, pneumonia and encephalopathy grade I V. He was transplanted on the third day of admission, in electrolyte balance.
On the next day, sound sick, opened his eyes, mobilized the four limbs with live reflexes and Babinski.
The patient remained active and barefoot.
On the seventh day prothrombin 70%, conscious, oriented, motor deficit of the four limbs, exhaled reflexes in lower limbs and Babinski.
On the suboptimal days motor communication improved, and recovery of fingers was initiated.
He still had hyperkinesia, without sensory impairment.
Twenty-day MRI showed a lesion in the central region of the protuberance, visible in T2 and FLAIR, and hypoxic lesions of the cingular cortex.
EEG had nonspecific slow activity.
Motor recovery was completed in two months, when transplant rejection was initiated, defined by biopsy.
Acute respiratory infection is installed.
At the third month, the patient did not speak due to archostomy, postural tremor, without motor deficit, symmetrical osteotendinous reflexes, and indifferent plantar reflexes.
Subsequently, multiple liver abscesses were detected.
The EEG was normal.
He developed a new pulmonary infection with multi-resistant tuberculosis and septic shock.
Ascites and thrombosis of the vena cava lead to hemodynamic collapse are found.
She died 120 days after the second transplant.
