SHM Converge Scientific Abstract ePoster Gallery-Acute Hepatitis B in Previously Unknown G6pd Deficiency

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This case describes a 73-year-old man who presented with one week of fatigue, dark urine, jaundice, nausea, vomiting, and poor appetite. He was found to have acute hepatitis B infection complicated by severe hemolysis, acute liver injury, and progressive renal failure. His admission labs showed markedly elevated AST/ALT, severe hyperbilirubinemia, elevated creatinine and BUN, hyperkalemia, anemia with very high reticulocyte count, low haptoglobin, and a low G6PD level, revealing previously undiagnosed glucose-6-phosphate dehydrogenase deficiency.<br /><br />Imaging showed no acute abdominal pathology. Kidney biopsy demonstrated acute tubular injury with bilirubin and hemoglobin casts, consistent with bile cast nephropathy and hemolysis-related kidney injury. As his condition worsened and he became oliguric, he required hemodialysis for six weeks. He was treated with entecavir for acute hepatitis B. Over time, both renal and liver function improved, allowing discontinuation of dialysis, though entecavir was continued long term.<br /><br />The authors emphasize that viral hepatitis can cause hemolytic anemia, but severe intravascular hemolysis with renal failure should prompt consideration of acute hepatitis infection and underlying G6PD deficiency. This case is notable because the patient’s G6PD deficiency had not been diagnosed despite his advanced age, and it is reported as the first case of severe hemolysis and renal failure precipitated by acute hepatitis B in a patient with undiagnosed G6PD deficiency. Early recognition is important to start antiviral therapy promptly and consider supportive measures such as plasmapheresis when needed.

Asset Subtitle

Zoe Weeks

Meta Tag

Author List Hira Imran, Natalie Dunlap, Nathaniel Rogers, Zoe Weeks

Category Clinical Vignettes

Concept Acute Hepatitis B

Concept Hemolysis

Concept Glucose-6-Phosphate Dehydrogenase Deficiency

Concept HBV Serology

Concept Renal Failure

Distinguished Non-Finalist

Presenter Organization University of Tennessee Health Sciences Center

Presenting Author Zoe Weeks

Track Adult

Keywords

acute hepatitis B

G6PD deficiency

hemolysis

renal failure

bile cast nephropathy

acute liver injury

hemodialysis

bilirubin casts

entecavir

intravascular hemolysis

Acute Hepatitis B

Hemolysis

Glucose-6-Phosphate Dehydrogenase Deficiency

HBV Serology

Renal Failure