Acute Hepatitis B Induced Liver Failure: A Rare but Preventable Threat to Healthcare Workers - Dr Vikram Raut

Acute Liver Failure (ALF) is a medical emergency associated with high short-term mortality, often progressing rapidly in previously healthy individuals. While chronic liver diseases such as alcoholic liver disease, Non-Alcoholic Fatty Liver Disease, and long-standing viral hepatitis account for the majority of liver transplants in India, acute liver failure due to Hepatitis B remains uncommon.

A recent case involving a young healthcare worker highlights how quickly this rare presentation can escalate and the critical importance of prevention through vaccination and timely post-exposure measures.

Hepatitis B virus (HBV) infection typically follows one of three clinical courses. Around 30–40% of infected adults clear the virus spontaneously with an effective immune response.

Another 50–60% may remain asymptomatic initially but progress over the years to chronic hepatitis, cirrhosis, or hepatocellular carcinoma. Only a small minority develop acute liver failure, making such cases rare but particularly dangerous due to their abrupt onset and rapid deterioration.

The case involves a 27-year-old resident doctor from a neighbourhood hospital who sustained an occupational hollow-bore needle-stick injury while performing a clinical procedure. The individual had not received Hepatitis B vaccination and did not report the exposure or receive post-exposure prevention.

Over the following weeks, he developed non-specific symptoms that rapidly progressed to jaundice, altered neuro symptoms, and bleeding tendencies, hallmarked features of acute liver failure.

Despite early hospitalisation, the disease course was quite strong. The patient developed Hepatic Encephalopathy and severe coagulopathy, indicating advanced liver failure with a high risk of mortality. Antiviral therapy, which can halt disease progression if initiated early in selected cases, was insufficient due to the rapid decline in liver function. Given the severity of illness and poor prognostic indicators, the patient was listed for a super-urgent liver transplant.

Unlike chronic liver disease, where transplantation is often planned and elective, acute liver failure requires immediate decision-making and rapid access to a suitable donor.

In this case, a living-donor liver transplant was performed within 24–48 hours, with the patient’s brother serving as the donor. The procedure was successful, and both donor and recipient recovered well, underscoring the life-saving role of timely transplantation in acute settings.

This case serves as a stark reminder that Hepatitis B remains an occupational hazard for healthcare workers, particularly those involved in emergency care, invasive procedures, and laboratory services. The risk is not limited to doctors alone but extends to nurses, technicians, housekeeping staff, and others who may be exposed to blood or bodily fluids.

Hepatitis B vaccination is highly effective, safe, and widely available, yet gaps in coverage persist. Equally important is immediate reporting of needle-stick injuries and adherence to post-exposure prophylaxis protocols, which can significantly reduce the risk of infection and severe outcomes.

While acute liver failure due to Hepatitis B is rare, its consequences can be catastrophic. This case reinforces the need for institutional policies that ensure universal vaccination, regular antibody checks, prompt exposure reporting, and ongoing education on occupational safety measures that can prevent a preventable disease from becoming a life-threatening emergency.

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