Here, we describe a 42-year-old male patient with late-onset hepatic failure (LOHF) due to acute-onset autoimmune hepatitis. At first, his response to steroid therapy was good, but hepatitis relapsed during steroid pulse therapy. Deterioration of liver function caused LOHF, and LOHF has a poor prognosis, particularly when it is complicated by infection. Systemic infection by Staphylococcus aureus resulted in a skin rash and septic pulmonary embolism, and is an absolute contraindication for liver transplantation (LT). In this treatment network, hepatologists and a transplant surgeon cooperated to overcome severe infection and their efforts led to successful transplantation. On-line hemodiafiltration is an indispensable treatment option for acute liver failure. Infection control is crucial for LT and an intensive medical care network led to successful living-donor LT.
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Compliance with ethical standards
Conflict of interest
Professor Katsutoshi Tokushige received research fundings from Sumitomo Dainippon Pharma Co., Ltd. Astellas Phama Inc. Eisai Co., Ltd. TAIHO Pharmaceutical Co., Ltd. Chugai Pharmaceutical Co., Ltd. Daiichi Sankyo Pharmaceutical Co., Ltd. AbbVie GK, Takeda Pharmaceutical Company Limited. Asahi Kasei Corporation. AJINOMOTO CO., Inc. Otsuka Pharmaceutical Co., Ltd. Other authors have no conflict of interest.
All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent was obtained from all patients for being included in the study.
Nakao M, Nakayama N, Uchida Y, et al. Nationwide survey for acute liver failure and late-onset hepatic failure in Japan. J Gastroenterol. 2018;53:752–69.CrossRefGoogle Scholar
Lee WM, Stravitz RT, Larson AM. Introduction to the revised American association for the study of liver diseases position paper on acute liver failure 2011. Hepatology. 2012;55:965–7.CrossRefGoogle Scholar
Soyama A, Eguchi S, Egawa H. Liver transplantation in Japan. Liver Transpl. 2016;22:1401–7.CrossRefGoogle Scholar
Alvarez F, Berg PA, Bianchi FB, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31:929–38.CrossRefGoogle Scholar
Kessler WR, Cummings OW, Eckert G, et al. Fulminant hepatic failure as the initial presentation of acute autoimmune hepatitis. Clin Gastroenterol Hepatol. 2004;2:625–31.CrossRefGoogle Scholar
Yoshiba M, Sekiyama K, Inoue K, et al. Accurate prediction of fulminant hepatic failure in severe acute viral hepatitis: multicenter study. J Gastroenterol. 2002;37:916–21.CrossRefGoogle Scholar
Cropley A, Weltman M. The use of immunosuppression in autoimmune hepatitis: a current literature review. Clin Mol Hepatol. 2017;23:22–6.CrossRefGoogle Scholar
Montano-Loza AJ, Carpenter HA, Czaja AJ. Features associated with treatment failure in type 1 autoimmune hepatitis and predictive value of the model of end-stage liver disease. Hepatology. 2007;46:1138–45.CrossRefGoogle Scholar
Ichai P, Duclos-Vallee JC, Guettier C, et al. Usefulness of corticosteroids for the treatment of severe and fulminant forms of autoimmune hepatitis. Liver Transpl. 2007;13:996–1003.CrossRefGoogle Scholar
McCormack MG, Smith AJ, Akram AN, et al. Staphylococcus aureus and the oral cavity: an overlooked source of carriage and infection? Am J Infect Control. 2015;43:35–7.CrossRefGoogle Scholar
Nesseler N, Launey Y, Aninat C, et al. Clinical review: the liver in sepsis. Crit Care. 2012;16:235.CrossRefGoogle Scholar
Katz S, Jimenez MA, Lehmkuhler WE, et al. Liver bacterial clearance following hepatic artery ligation and portacaval shunt. J Surg Res. 1991;51:267–70.CrossRefGoogle Scholar
Eguchi Y, Sugimoto H. Septicaemia. Jpn J Acute Med. 2003;27:576–7.Google Scholar
Cook RJ, Ashton RW, Aughenbaugh GL, et al. Septic pulmonary embolism: presenting features and clinical course of 14 patients. Chest. 2005;128:162–6.CrossRefGoogle Scholar
Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36:3075–128.CrossRefGoogle Scholar
Murray RJ. Staphylococcus aureus infective endocarditis: diagnosis and management guidelines. Intern Med J. 2005;35:25–44.CrossRefGoogle Scholar
Abid Q, Price D, Stewart MJ, et al. Septic pulmonary emboli caused by a hemodialysis catheter. Asian Cardiovasc Thorac Ann. 2002;10:251–3.CrossRefGoogle Scholar
Ye R, Zhao L, Wang C, et al. Clinical characteristics of septic pulmonary embolism in adults: a systematic review. Respir Med. 2014;108:1–8.CrossRefGoogle Scholar
MacMillan JC, Milstein SH, Samson PC. Clinical spectrum of septic pulmonary embolism and infarction. J Thorac Cardiovasc Surg. 1977;75:670–9.Google Scholar
Takeda K, Tanaka K, Kumamoto T, et al. Septic pulmonary embolism originated from subcutaneous abscess after living donor liver transplantation: a pitfall of postoperative management. Clin J Gastroenterol. 2013;6:378–82.CrossRefGoogle Scholar
Golpe R, Marin B, Alonso M. Lemierre’s syndrome (necrobacillosis). Postgrad Med J. 1999;75:141–4.CrossRefGoogle Scholar