SHM Converge Scientific Abstract ePoster Gallery-Septicemia and Empyema With Hepatic Hydrothorax Related to Autoimmune Hepatitis

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This case describes an 84-year-old woman with autoimmune hepatitis who developed severe infectious complications in the setting of liver failure and likely cirrhosis. She had been diagnosed three months earlier after acute liver failure, positive anti–smooth muscle antibody (1:320), and liver biopsy showing submassive necrosis with bridging inflammation. She was discharged then on a steroid taper.<br /><br />On readmission, she presented with shortness of breath and abdominal pain and was found to have severe sepsis with lactic acidosis due to Escherichia coli bacteremia. Her illness progressed to E. coli bacterial peritonitis and empyema, along with hepatic hydrothorax shown on CT as large pleural effusions. She was treated with broad-spectrum antibiotics, later narrowed to ceftriaxone based on sensitivities, but continued to worsen clinically with confusion, agitation, and respiratory distress requiring continuous BiPAP. After discussion with family, care was transitioned to inpatient hospice.<br /><br />The report highlights that autoimmune hepatitis can present as acute liver injury and, if untreated or severe, may progress to cirrhosis. Hepatic hydrothorax is an uncommon but recognized complication of cirrhosis, occurring in about 5–15% of patients, likely due to ascitic fluid moving through diaphragmatic defects into the pleural space. In this patient, the authors propose that E. coli translocated from the gut into the bloodstream and ascitic fluid, then reached the pleural cavity through the diaphragm, causing empyema. Steroid therapy and autoimmune hepatitis likely contributed to ascites and immunosuppression, increasing her risk for severe sepsis.

Asset Subtitle

Zaid Shah

Meta Tag

Author List Subhan Tabba, Sunny Narula, Tapan Patel, Zaid Shah

Category Clinical Vignettes

Concept Autoimmune Hepatitis

Concept Cirrhosis

Concept Hepatic Hydrothorax

Concept Immunosuppression

Concept Empyema

Distinguished Non-Finalist

Presenter Organization Texas Health Presbyterian

Presenting Author Zaid Shah

Track Adult

Keywords

autoimmune hepatitis

acute liver failure

cirrhosis

Escherichia coli bacteremia

sepsis

bacterial peritonitis

empyema

hepatic hydrothorax

steroid therapy

immunosuppression

Autoimmune Hepatitis

Cirrhosis

Hepatic Hydrothorax

Immunosuppression

Empyema