Clinical Recovery in Probable Acute Hepatitis B with Severe Hepatocellular Injury: A Case Report

Abstract

Acute hepatitis is characterized by hepatocellular injury and may result from viral, drug-induced, autoimmune, 
ischemic, or other causes. We report the 30-day clinical, biochemical, serological, and ultrasonographic course of 
a 26-year-old woman with probable acute hepatitis B-associated severe hepatocellular injury. She presented with 
jaundice, fatigue, digestive discomfort, and constipation. Baseline investigations revealed marked hepatocellular 
injury, with alanine aminotransferase (ALT) 2,526 U/L, aspartate aminotransferase (AST) 2,086 U/L, total bilirubin 
7.3 mg/dL, and direct bilirubin 4.9 mg/dL. Hepatitis B surface antigen was reactive (44.49 S/CO), while ultrasonography 
showed mild hepatomegaly, periportal edema, and gallbladder wall thickening without biliary obstruction. After 
approximately 10 days of hospitalization and supportive care, including nutritional supplementation, substantial 
biochemical improvement was observed by day 30: ALT 58 U/L, AST 59 U/L, total bilirubin 1.3 mg/dL, and direct 
bilirubin 0.59 mg/dL. Jaundice and presenting symptoms resolved. However, immunoglobulin M hepatitis B core 
antibody, hepatitis B e antigen/hepatitis B e antibody, and hepatitis B virus (HBV) DNA were not obtained; therefore, 
acute HBV infection could not be definitively confirmed.