B0590 - Hepatitis B Causing Severe Hemolysis and Multi-Organ Failure in Patients With Undiagnosed G6PD

Hira Imran, MD¹, Zoe Weeks, MD², Natalie Dunlap, MD², Nathaniel Rogers, MD^2
1University of Tennesse Health Science Center, Memphis, TN; ²UTHSC, Memphis, TN

Introduction: Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease. WHO estimates 1.5 million new infections annually. Most people remain asymptomatic; however, some people have acute illness that lasts several weeks, which can at times be complicated with acute liver failure. Glucose-6-phosphate dehydrogenase (G6PD) X-linked deficiency is the most common human enzymopathy.

Case Description/Methods: A 73-year-old male presented with loss of appetite, and dark colored urine.




On examination, vitals were within normal range. Scleral icterus was present, along with hepatomegaly. Patient was alert and oriented. Patient's lab work was concerning for AST was 3017 unit/L, ALT 2712 Unit/L, BUN 74 mg/dL, Cr 3.6 mg/dL, total bilirubin 72.4 mg/dL, direct bilirubin 41.8 mg/dL, indirect bilirubin 30.6 mg/dL, hemoglobin 12.9 g/dL, white count 17,000 per microliter and platelet count of 173,000 per microliter (mcL).




Patient’s hepatitis panel was positive for Hepatitis B Core Antibody Total, Hepatitis B Core Antibody IgM, Hepatitis B Surface Antibody, log 10 HBV IU/mL 2914.




Hematological work up was done which was concerning for LDH 4,875, ferritin > 7500, reticulocyte, Peripheral smear did not show schistocytes.




Erythrocyte G6PD level was performed which was low




Patient was started on hemodialysis due to electrolyte derangement and oliguria. The patient was given intravenous fluids and was started on Entecavir for acute complicated Hepatitis B infection, Renal Biopsy was done which was suggestive of acute tubular injury.




Patient liver function, labs as well as renal function continued to improve and no longer required dialysis.

Discussion: Hemolytic anemia has been associated with viral hepatitis, but the degree is usually mild to moderate. With cases of severe intravascular hemolysis, a diagnosis in addition to hepatitis should be sought out.




Our case is unique since this is the first reported case of severe hemolysis and renal failure precipitated by acute HBV in an undiagnosed G6PD deficient patient and treatment with Entecavir causing marked improvement.




With early recognition and establishing diagnosis of complicated hepatitis B leading to severe hemolysis as well as renal failure, prompt treatment with anti-viral as well as supportive treatment for G6PD deficiency can help with early recovery of patients and prevent life threatening organ failure.


Disclosures:


Hira Imran, MD¹, Zoe Weeks, MD², Natalie Dunlap, MD², Nathaniel Rogers, MD². B0590 - Hepatitis B Causing Severe Hemolysis and Multi-Organ Failure in Patients With Undiagnosed G6PD, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.