Massive hemolysis complicating acute granulomatous hepatitis
Letter to the Editor
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A 51-year-old man was admitted to our hospital because of abdominal pain, fever, and jaundice. He reported a recent sexually risky contact. At admission, blood test revealed normal renal function and blood cell count and an acute hepatitis with AST/ALT 3560/4513 UI/L, total bilirubin 18 mg/dL, and INR 1.53. Liver ultrasound showed no alterations. The patient was hospitalized, received IV vitamin K, and underwent liver biopsy and a complete laboratory study. Within the next 48 h, his clinical condition markedly deteriorated with impairment of liver function (INR 1.83, total bilirubin 53.6 mg/dL—indirect 12.1 mg/dL), development of grade III acute kidney injury (creatinine 3.2 mg/dL), behavioral changes without flapping, and hemolytic anemia: hemoglobin decreased from 110 to 54 g/L, high reticulocyte count (19%) and low haptoglobin levels. Peripheral blood smear showed acute hemolysis with presence of “bite” cells and “blister cells,” as well as microspherocytes,...
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Conflict of interest
The authors declare that they have no conflict of interest.
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