FULMINANT-HEPATITIS COMPLICATED BY SMALL-INTESTINE INFECTION AND MASSIVE HEMORRHAGE

A 34-year-old man diagnosed with fulminant hepatitis, caused by hepati tis B virus, and acute renal failure was referred to our hospital. Aft er admission to the intensive care unit, the liver and renal failure w ere ameliorated. Melena requiring transfusion occurred during the cour se of his illness. Endoscopic examination demonstrated pseudomembranes , erosions, ulcers, and hemorrhage in the duodenum, the upper jejunum, and the terminal ileum, suggesting widespread lesions throughout the small intestine. Pseudomonas putida, Xanthomonas maltophilia, and Cand ida glabrata were cultured from ileal fluid. Candida glabrata was also detected in sputum, feces, and on an intravenous catheter tip. The pa tient was treated with amphotericin B and miconazole. The melena was a meliorated. but inflammation of the small intestine persisted. Althoug h we had difficulty in treating the enteritis, the patient survived, a nd 1 year later colonoscopic examination demonstrated no abnormalities . The small intestine is a difficult site to examine, but endoscopic e xamination of this site is important when massive hemorrhage develops.