Fulminant Hepatic Failure in Glucose-6-Phosphate Dehydrogenase (G6PD) Deficient Patients Caused by Hepatitis E Infection: A Single Disease With Different Spectrums

One of the major causes of acute viral hepatitis in Pakistan is the hepatitis E virus. Virus-induced liver inflammation within sight of glucose-6-phosphate dehydrogenase (G6PD) insufficiency might be related with intricacies, for example, extremely low hemoglobin, red blood cell (RBC) destruction, renal function collapse, a decline in brain function due to severe liver disease and even demise. Despite the two diseases being widespread, their effect on understanding patient ailment has not been studied in depth. Hemolytic anemia occurs as a complication of acute hepatitis. Nevertheless, the occurrence can ascend to a large percentage of patients harboring glucose-6-phosphate dehydrogenase (G6PD) insufficiency. Although being frequent in endemic countries, there is a lack of literature in understanding the synergistic effect of hepatitis E disease and G6PD inadequacy leading to fulminant hepatic failure and increased mortality in the absence of a liver transplant facility. Here we report a case of two brothers, both having G6PD deficiency. A 19-year-old male, the elder of the two brothers, came with three days of complaints of persistent vomiting and deep jaundice. On investigation, he was found to have acute hepatitis E. During his hospital stay, he became drowsy, comatose, and subsequently expired. The second patient, his younger brother, was a 15-year-old male who presented with similar history about one week after his demise. He was also managed conservatively and was subsequently discharged from the hospital.