LATE-ONSET HEPATIC-FAILURE DUE TO HEPATITIS-B VIRUS WITH MUTATIONS INTHE PRECORE REGION

A 60-year-old man complained of severe general fatigue on October 11, 1992. Pertinent laboratory findings were: aspantate aminotransferase ( AST) 1920 IU, alanine aminotransferase (ALT) 2050 IU, and total biliru bin (T.Bil) 124 micromol/l (normal range, 0 - 17 micromol/l). Virologi cal assay revealed that hepatitis B surface antigen (HBsAg), anti-hepa titis B e (HBe), anti-HBc, and immunoglobulin M (IgM) anti-HBc were po sitive, and anti-HBs, HBeAg, and anti-delta antibody were negative. A diagnosis of acute hepatitis due to hepatitis B virus was made. Despit e a decrease in transaminase, jaundice worsened and prothrombin time w as prolonged. On the 60th day of hospitalization, massive ascites deve loped, but the patient's consciousness was not impaired. Although albu min and diuretics were given, the ascites further increased. Paracente sis of 2000 ml of ascitic fluid was performed twice a week. On the 120 th day of hospitalization, the patient passed black stools and he exhi bited renal failure 3 weeks later. Although severe jaundice persisted, he was still alert. On the 150th day of hospitalization, massive gast rointestinal bleeding occurred, due to hemorrhagic gastritis. Despite receiving intensive care, the patient died. Determination of the HBV D NA sequence revealed two point mutations in the pre-core region; these have not been reported elsewhere.