Recurrent fulminant liver failure caused by hepatitis B virus after liver transplantation

We report a 44-year-old man who received a liver graft because of fulminant liver failure due to hepatitis B virus. Nine months later a new episode of acute hepatitis B followed a fulminant course and led to another transplantation. The patient died due to invasive aspergillosis and multiorgan failure 3 weeks after the second transplant. This case reveals that hepatitis B virus reinfection may also occur after transplantation in patients with fulminant hepatitis B and under immunosuppression circumstances. Although immunoprophylaxis with hepatitis B hyperimmune globulin may prevent hepatitis B reinfection, it does not guarantee complete protection even in patients presumed to have low risk of reinfection. Finally, this case confirms the high risk of fungal infections in patients with fulminant liver failure and the need to establish early antifungal therapy.