SEVERE HYPERBILIRUBINEMIA DUE TO ACUTE HEPATITIS-A SUPERIMPOSED ON A CHRONIC HEPATITIS-B CARRIER WITH GLUCOSE-6-PHOSPHATE-DEHYDROGENASE DEFICIENCY

Taiwan is an endemic area for hepatitis A and B virus infections; near ly 90% of adults have serological markers for either virus, Glucose-6- phosphate dehydrogenase (G6PD) deficiency is also common, ranging from 2% to 10%, We report the case of a 36-yr-old chronic HBV male carrier with G6PD deficiency who developed acute viral hepatitis A with sever e hyperbilirubinemia and intravascular hemolysis, The hemolysis was in all likelihood the result of recent exposure to sulfa drugs, Fulminan t hepatitis was the initial impression, because the peak serum total b ilirubin concentration was alarmingly high, at 85.4 mg/dl, Exchange pl asmapheresis with fresh frozen plasma was performed, and various labor atory studies gradually returned to near normal over the next 3 wk, Th e patient made an uneventful recovery 1 month after admission.