HEPATITIS-C VIRUS-ASSOCIATED FULMINANT HEPATIC-FAILURE

FULMINANT hepatic failure is a dramatic clinical syndrome characterize d by massive necrosis of liver cells.(1) It is most often caused by he patitis A virus and hepatitis B virus (HBV)(2); whether hepatitis C vi rus (HCV) can cause it is still controversial.(3,4) Among patients wit h non-A, non-B fulminant hepatitis, antibodies against HCV (anti-HCV) or serum HCV RNA were found in 40 to 60 percent in Japan(5,6) and Taiw an,(7) but in only 2 percent (range, 0 to 12 percent) in Western count ries,(8-13) with one exception: a recent study conducted in California reported a prevalence of 60 percent associated with low socioeconomic status and Hispanic ethnicity.(14) Whether these discrepancies reflec t geographic differences in the epidemiology of HCV infection or the p athogenicity of the prevalent viral strains is not known. Furthermore, because of the dramatic course of fulminant hepatic failure, in most patients only a single serum sample, often obtained late in the course of the disease, was studied. In this report, we describe a patient wi th HCV-associated fulminant hepatitis in whom serial studies were done that provided a unique opportunity to establish a temporal associatio n between the acquisition of HCV infection and the development of fulm inant hepatitis and to define the clinical, virologic, and histologic profile of fulminant hepatitis C.