A 27-year-old man with no morbid history consulted in Antofagasta for general malaise and fever for 5 days, with subsequent onset of jaundice.
The patient was hospitalized with a total of 13 mg/dl, an aminotransferase of 1,977 mU/ml of acetic acid, 1,977 mU/ml of civic acid, 5.975 mU/ml of bilirubin and alkaline prothrombin, 157
The viral panel was positive for HBsAg.
Glasgow Coma Scale score was 8. Computed tomography (CT) of the normal brain revealed consciousness.
She was admitted to the Intensive Care Unit with Glasgow 5, suffering bronchoaspiration.
He was connected to mechanical ventilation, antibiotics and N-acetyl cysteine were started.
Chest CT revealed pneumonia, and brain CT showed mild cerebral edema.
Abdominal ultrasound revealed normal mucus and mild ascites.
When sedation was discontinued, the patient continued to have coma and refractive pupils.
The evolution of laboratory tests is shown in Table 1.
1.
Within the etiologic study presents serology for hepatitis C and A virus and study of autoimmunity (antibodies and immunoglobulin count) negative.
The HBV study was repeated, highlighting the appearance of antibodies against HBsAg (antiHBs) and negativization of HBsAg, with positive anticore, IgM and total.
HIV ELISA was positive, and CD4 count of 634 cells/ul.
HBV viral load was 140 copies/ml, and HIV viral load was 16,900 copies RNA/ml.
ART was initiated on the second day with emtricitabine, tenofovir and raltegravir to cover both viruses.
The need for liver transplantation (LTHO) was raised, but respiratory infection does not allow activation as an emergency.
Molecular Adjustment Therapy sessions were performed at 31 hours.
Six days after admission, the patient developed new respiratory deterioration and was treated for nosocomial pneumonia.
Washout with multiple organ failure and sepsis of pulmonary focus (with Enterococcus faecalis in bronchioalveolar).
Oliguria was finally added, introducing continual veno-venosa.
Twelve days after admission, the patient presented with mydriasis and CT showed large cerebral edema with brainstem compression.
She died 2 weeks after admission.
