Acute liver failure induced by hepatitis E virus complicated with pancreatitis and refractory acute respiratory distress syndrome after rapid ascent to high altitude: a case report and literature review

Le résumé fourni par la source

Background Acute respiratory distress syndrome (ARDS) and pancreatitis are fatal extrahepatic complication of hepatitis E virus (HEV)–induced acute liver failure (ALF). High-altitude hypobaric hypoxia may exacerbate pulmonary endothelial injury and delay tissue repair, but its impact on the severity and reversibility of ALF-related pancreatitis and ARDS remain uncharacterized. Case presentation A 44-year-old male (Body mass index 31.7 kg/m 2 ) presented with jaundice, oliguria and progressive hypoxemic respiratory failure 1 month after rapid ascent from 1,190 m to 3,650 m. He was diagnosed with HEV-associated ALF, severe refractory ARDS, stage 3 acute kidney injury (AKI) and concurrent severe acute pancreatitis. Despite lung-protective ventilation, neuromuscular blockade and daily prone positioning, hypoxemia remained refractory at high altitude. The patient also received continuous renal replacement therapy and artificial liver support with dual plasma molecular adsorption system plus double filtration plasmapheresis. After 17 days, his condition stabilized but ARDS and AKI recovery was delayed. Following transfer to a hospital at 500 m altitude, oxygenation, liver and kidney function improved significantly within 3 weeks. Conclusion Sustained high-altitude hypoxia may contribute to refractoriness and delayed recovery of ALF-related ARDS. Altitude descent may be a valuable adjuvant strategy for hemodynamically stable patients with refractory hypoxemia, pending further prospective validation.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.