DPMAS in the Management of Severe Acute Liver Injury

Acute liver injury is a severe disease in which a hepatic and later systemic inflammatory response is triggered, generally induced by paracetamol intoxication, undetermined causes, drugs, and hepatotropic and nonhepatotropic viruses.

A 67-year-old immunocompetent male with severe acute liver injury secondary to Cytomegalovirus (CMV) infection presented with a 2-week history of anorexia, asthenia, adynamia, generalized weakness, myalgia, and jaundice. Laboratory tests revealed hyperbilirubinemia, hypertransaminasemia, coagulopathy, and acute kidney injury, and tests for hepatitis A, B, C, HIV, and autoimmune hepatitis were negative, while PCR was positive for CMV. Patient was treated with N-acetylcysteine, albumin, valganciclovir, and liver support therapy using the dual plasma molecular adsorption system (DPMAS). Fundus examination showed CMV retinitis, and liver biopsy confirmed acute hepatitis with CMV cytopathic changes and areas of hepatocyte regeneration. After 5 sessions of DPMAS and 4 weeks of antiviral therapy, he showed clinical and biochemical improvement with native liver recovery and was discharged with outpatient follow-up.

This case highlights the successful early recognition and prompt initiation of appropriate treatment using antiviral therapy and liver support therapy in managing severe CMV-induced acute liver injury in an immunocompetent patient, potentially averting the need for liver transplantation.