Acute liver failure in an immunocompetent patient.

A 14-year-old immunocompetent female showed clinical signs of severe hepatitis. The diagnosis of hepatic encephalopathy was by clinical signs and symptoms: reduction of consciousness, mental confusion, and hepatomegaly, edema in upper and lower limbs during physical examination. Clinical chemistry revealed total and direct bilirubin of 49.9 mg/dl (normal 0.1–1.2 mg/dl) and 31(<0.4 mg/dl) respectively, alanine transaminase (ALT) levels of 1393 U/L (<50 U/L) and aspartate transaminase (AST) levels of 1773 U/L (<36 U/L), and severe diminished prothrombin activity...