Case history
Case history #1
A 47-year-old man from eastern Europe presents with fatigue and oedema. He has no other medical history. Examination shows multiple spider naevi on the anterior and posterior chest, no icterus, a soft abdomen with a palpable spleen tip, palmar erythema, and mild pitting oedema of both ankles. Laboratory studies show an alanine aminotransferase of 121 IU/L, total bilirubin 32.49 micromoles/L (1.9 mg/dL), platelet count 90,000, creatinine 61.89 micromoles/L (0.7 mg/dL), and international normalised ratio (INR) of 1.4.
Case history #2
A 23-year-old woman presents with several weeks of fatigue and malaise. Her urine is dark and she has some diffuse abdominal pain. She has a history of active injection drug use. Examination shows normal vital signs but a low-grade fever of 37.8°C (100.1°F), scleral icterus, and a soft abdomen without hepatosplenomegaly. Laboratory studies show an alanine aminotransferase of 237 IU/L, alkaline phosphatase 102 IU/L, total bilirubin 97.47 micromoles/L (5.7 mg/dL), and international normalised ratio (INR) of 1.1.
Other presentations
Most people with chronic hepatitis D virus (HDV) infection will be asymptomatic. Occasionally, acute co-infection (simultaneous infection with hepatitis B virus [HBV] and HDV) or superinfection (HDV infection of a person with chronic HBV infection) can present with acute liver failure. This can present with non-specific symptoms including fever, fatigue, malaise, nausea, abdominal pain, dark urine, pale stool, diarrhoea, and jaundice. The development of asterixis or other signs of encephalopathy including somnolence or coma are indications of cerebral oedema and the need for urgent liver transplantation.
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