![]() ![]() However, we could not obtain HEV IgM and HEV IgG results because the process required 3 weeks. To address the acute exacerbation of hepatic function, serologic tests, chest X-ray, urine analysis, and paracentesis (ascites analysis: WBC, 96/μL red blood cells, 650/μL neutrophils, 8% lymphocytes, 17% other cells, 75% and no growth in culture study) were performed, but there was no infection focus and the results of viral markers were all negative (anti-hepatitis A virus immunoglobulin M hepatitis B surface antigen/anti-hepatitis B surface antibody anti-hepatitis B core antigen IgM anti-hepatitis C virus and serological results for acute Epstein-Barr and cytomegaloviral infection). According to the CT imaging findings, the possibility of jaundice due to HCC progression was low. Abdominal computed tomography (CT) showed necrotic HCC accompanied by left lobe shrinkage and partial thrombosis involving the main, left, and right portal veins, as well as the superior mesenteric vein, without biliary obstruction ( Fig. The C-reactive protein concentration was 1.62 mg/dL. His blood hemoglobin (Hb) was 11.4 g/dL the white blood cell (WBC) count was 6×10 3/μL and his platelet count (PLT) was low at 34×10 3/μL. The other test results were as follows: gamma-glutamyltransferase, 49 IU/L elevated alkaline phosphatase activity, 149 IU/L albumin, 3.1 g/L and international normalized ratio (INR), 1.39. Laboratory and imaging findings He showed high bilirubin (total bilirubin : 33.1 mg/dL, direct bilirubin : 24.5 mg/dL) compared to his previous value (T-bilirubin: 1.27 mg/dL) and normal alanine aminotransferase (ALT) and elevated aspartate aminotransferase (AST) levels (ALT: 27 IU/L, AST: 48 IU/L). ![]() His only recent medicine before hospitalization was amoxicillin and clavulanic acid for one week for mild flu-like symptoms. There was no history of herbal medications. The patient presented with yellowish skin color and was thin except for the abdominal distension, which had developed 10 days earlier. The HCC did not progress after the development of spontaneous necrotic change. Instead, he abstained from alcohol consumption and maintained a good general condition, without ascites, jaundice, or encephalopathy. After a diagnosis of alcoholic LC and HCC on 21 November 2016, he refused treatment for HCC. Clinical findings A 63-year-old man was referred to Eulji University Hospital for severe jaundice and abdominal distension on. Here, we report a 63-year-old man with alcoholic LC and necrotic HCC who died of hepatic insufficiency due to HEV infection. Although well-known risk factors, such as the consumption of alcohol and herbal medicines, are emphasized, preventive education for HEV infection is not sufficiently practiced. INTRODUCTION In patients with hepatocellular carcinoma (HCC) or liver cirrhosis (LC), hepatitis E virus (HEV) infection often leads to debility through rapid deteriotation of hepatic function. Keywords: Hepatocellular carcinoma Regression Hepatitis E virus Liver failure.Therefore, clinicians should pay more attention to the prevention of HEV and others causes of direct liver injury. Liver function preservation is important when treating HCC patients. The patient progressed to hepatorenal syndrome and eventually died. His umbilical hernia deteriorated due to tense ascites and infection by skin abrasion. The patient often ate raw oysters and sashimi, as well as boar meat, which is a well-known risk food for HEV infection. One month later, HEV immunoglobulin M positivity was confirmed, and deterioration of liver function due to HEV infection was suspected. The patient reported no herbal medicine or alcohol consumption, and there was no evidence of acute viral hepatitis. Laboratory and imaging findings revealed no acute infection focus. Abdominal computed tomography showed necrotic HCC accompanied by left lobe shrinkage without tumor progression. Here, we report about a 63-year-old man with alcoholic LC who was referred to our hospital with jaundice and abdominal distension 10 days earlier. In patients with hepatocellular carcinoma (HCC) or liver cirrhosis (LC) accompanied by hepatitis E virus (HEV) infection, hepatic failure often leads to debility. ![]()
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