Therapeutic Plasma Exchange in Parvovirus B19-induced Acute Hepatic Failure

Area of Science:

• Hepatology
• Virology
• Critical Care Medicine

Background:

• Parvovirus B19 is a rare but serious cause of acute liver failure (ALF), a condition with high mortality.
• Pediatric data on managing ALF, particularly with plasma exchange, is limited.
• Therapeutic plasma exchange (TPE) is recognized for removing harmful substances and supporting patients awaiting liver transplantation.

Purpose of the Study:

• To report a successful case of managing parvovirus B19-induced acute liver failure in a pediatric patient using therapeutic plasma exchange.
• To highlight TPE as a potential treatment modality in resource-limited settings where liver transplantation is not immediately available.

Main Methods:

• A case report of a 16-year-old female patient diagnosed with stage 4 encephalopathy and coagulopathy due to parvovirus B19 infection.
• High-volume therapeutic plasma exchange (TPE) was administered as the primary treatment.
• Clinical outcomes and management strategies were documented.

Main Results:

• The patient with parvovirus B19-induced acute liver failure showed successful recovery following high-volume TPE.
• TPE effectively managed coagulopathy and encephalopathy, serving as a crucial intervention.
• This approach was utilized due to the non-availability of in-hospital liver transplant facilities.

Conclusions:

• Parvovirus B19 should be considered a potential, possibly underdiagnosed, cause of acute viral hepatitis and liver failure.
• Therapeutic plasma exchange can serve as an effective bridge to liver transplantation or a bridge to recovery, especially in self-limiting conditions like viral hepatitis.