Fulminant hepatitis A in patients with chronic liver disease

Fulminant hepatitis is a rare complication of acute hepatitis A virus (HAV) infection. We report three cases of fulminant hepatic failure with death d ue to HAV infection in patients with pre-existing chronic liver disease. Da ta from the literature also indicate a high case fatality rate during HAV s uperinfection in patients with chronic hepatitis B, particularly chose with cirrhosis, and in patients with alcoholic cirrhosis. In patients with chro nic hepatitis C, results are conflicting with some reports indicating a hig h fatality rate of HAV superinfection and others not, irrespective of the p resence or absence of cirrhosis. Based on our observations and this review of the literature, we suggest that patients with chronic liver disease shou ld be vaccinated against hepatitis A.