Liver dysfunction involving
toluene intoxicity includes elevation of
transaminase level and delayed complications of
liver failure, but its effect on hepatitis B virus (HBV)
infection is as yet unknown. Here, we report a case of
fulminant hepatitis B developed in a
toluene abuser. A 23-year-old female
toluene abuser was admitted to a local clinic because of
nausea,
vomiting, and
dizziness, and a mild elevation of serum
transaminase level was identified. She was treated as an outpatient, but continued
toluene inhalation during follow-up. Five days later, she was found in a drowsy state of consciousness and taken to the emergency unit of our institution. Laboratory findings showed an
alanine aminotransferase level of 4,659 IU, a remarkably prolonged prothrombin time, and she was diagnosed with
fulminant hepatitis B.
Intensive care was carried out, but she died the next day. Molecular analysis revealed that the HBV isolate was classified as genotype C, and
nucleotide positions that are prone to
fulminant hepatitis were A at 1,762 and G at 1,764 in the core promoter region, and G at 1,896 in
codon 28 in the precore region. The long-term
toluene inhalation could have contributed to drastic
clinical course of acute
hepatitis B in this patient.