13 October 2020
: Case report 
A Case of Fulminant Liver Failure in a 24-Year-Old Man with Coinfection with Hepatitis B Virus and SARS-CoV-2
Unusual clinical course
Elrazi Ali1ABDEFG*, Hisham Ziglam2ABD, Samah Kohla3EG, Mohanad Ahmed1CDEFG, Mohamed Yassin4ADEDOI: 10.12659/AJCR.925932
Am J Case Rep 2020; 21:e925932
Table 1. Shows the lab investigation done for the patients, including toxicology screen, liver function, hepatitis serology, and inflammatory markers.
| Lab result | Normal range | |
|---|---|---|
| Blood group | O positive | |
| WBC | 10×10/uL | 4–10×10/uL |
| Absolute neutrophil count | 7.0×10/uL | |
| Eosinophil count | 0.0×10/uL | 0–0.5 |
| Lymphocyte | Count 1.7×10/uL | 1–3×10/uL |
| Hemoglobin | 13.9 gm/dL | 13–17 gm/dL |
| Platelets | 64×10/uL | 150–400 10/uL |
| Creatinine | 305 | 62–106 umol/L |
| urea | 8.7 umol/L | 2.8–8.1 umol/L |
| PH | 7.14 | 7.350–7.450 |
| HCO | 7 mmol/L | 22–29 mmol/L |
| Glucose | 3.2 mmol/L | 3.3–5.5 mmol/L |
| Lactate | 22.8 mmol/L | 0.5–2.2 mmol/L |
| ALT | >7000 U/L | 0–41 U/L |
| AST | >7000 U/L | 0–40 U/L |
| INR | 9.8 | Critical high >4.9 |
| Prothrombin time | 84.9 | 7.9–11.8 |
| bilirubin | 115 umol/L | 0–21 umol/L |
| Albumin | 37 gm/L | 35–53 gm/L |
| LDH | 1,134 U/L | 135–225 U/L |
| Ammonia | 268 umol/L | 16–60 umol/L |
| D-dimer | 11.51 mg/L FEU | 0–0.44 mg/L FEU |
| Fibrinogen | 0.8 gm/L | 2–4.1 gm/L |
| Cholesterol | 0.7 mmol/L | Normal: <1.7 mmol/L |
| TAG | 0.7 mmol/L | Normal: <1.7 mmol/L |
| Acetaminophen level | 193 umol/L | Therapeutic Range: 66–199 umol/L |
| Ethanol level | <2.2 mmol/L | Critical: >44.9 mmol/L |
| Salicylate | <0.3 mg/dL | Therapeutic range: 15–30 mg/dL for Anti-inflammatory/Rheumatic condition, Toxic: >30 mg/dL, Lethal: >60 |
| CRP | 67.4 mg/L | 0–5 mg/L |
| Ferritin | 20,573.0 ug/L | 38–270 ug/L |
| Procalcitonin | 4.89 ng/mL | >2.0 ng/mL represents a high risk of sever sepsis and/or septic shock ng/mL |
| Blood culures | Negative | |
| HIV Ag/Ab combo | Negative | |
| Hepatitis C Ab | Negative | |
| Hepatitis c PCR | Negative | |
| Hepatitis A total Ab | Negative | |
| Hepatitis B S Ag | Positive | |
| Hepatitis B S Ag Ab | <2.00 | Antibody titers of ≥10 mIU/ml post HBV vaccination confirms successful |
| Hepatitis B S Ag | Positive | |
| Hepatitis B PCR | >170,000,000 IU/mL | |
| Hepatitis B core Ab IgM | Positive | |
| Hepatitis B e Ag | Positive | |
| Hepatitis B e Ab | Negative | |
| Hepatitis D Ab | Negative |