HYPOXIC HEPATITIS - A DIFFICULT DIAGNOSIS WHEN THE CARDIOMYOPATHY REMAINS UNRECOGNIZED AND THE COURSE OF LIVER-ENZYMES FOLLOWS AN ATYPICAL PATTERN - A REPORT OF 2 CASES

In a clinical setting of cardiac or circulatory failure, the diagnosis of hypoxic (ischaemic) hepatitis is easy and can be elicited on mere clinical and biochemical features. We report two cases of hypoxic hepa titis where cardiomyopathy remained unrecognized at admission due to t he lack of conventional signs of congestive heart failure and where th e increase in liver enzymes activities followed an atypical pattern, c haracterized by only moderate elevation of serum aminotransferases act ivities, low ASAT/ALAT ratio and elevated ALAT/LDH ratio. This atypica l pattern not suggestive of hypoxic hepatitis, could be explained by a delay between the onset of hypoxic injury of the Liver and admission to hospital. Moreover one case was complicated by frank jaundice, an u nusual feature in hypoxic hepatitis. Consequently, diagnosis and appro priate inotropic treatment were delayed resulting in progressive deter ioration and eventually death of both patients. The report of these tw o cases and the review of other similar cases previously published, en lighten some atypical features of hypoxic hepatitis.