Abstract / Summary
Abstract Background Acute-on-chronic liver failure (ACLF) in patients with chronic hepatitis B and cirrhosis carries an extremely high short-term mortality rate. We report a case of successful reversal of end-stage liver failure and cirrhosis by combined Chinese-Western medicine, followed by a fatal relapse after self-discontinuation of antiviral therapy. Case Presentation A 36-year-old male with a 9-year history of hepatitis B was admitted to a tertiary liver disease hospital in Beijing on November 10, 2007, with decompensated cirrhosis, massive ascites, and infection. Despite medical management, his condition deteriorated, with laboratory tests on December 17, 2007, showing a prothrombin activity (PTA) of 28.7%, an INR of 2.585, and a total bilirubin of 136.5 μmol/L, indicating irreversible end-stage liver failure with classic bile-enzyme separation. The family was informed that no curative treatment was available, and the patient was discharged against medical advice on December 19, 2007. Combined Chinese-Western medicine treatment was initiated at our institute on the same day. After 8 days of treatment, PTA rapidly increased to 46.3%, and INR decreased to 1.77. Liver function and coagulation profiles gradually normalized over the following months. By 2012, all laboratory parameters, including PTA (100%) and INR (1.01), had returned to normal, with resolution of splenomegaly and imaging evidence of cirrhosis reversal. The patient remained clinically stable for 5 years. In late 2012, the patient self-discontinued lamivudine for 3 months, leading to ACLF relapse. Due to delays in receiving standardized emergency care at two consecutive hospitals without artificial liver support technology, the patient ultimately died. Conclusion This case demonstrates the remarkable potential of combined Chinese-Western medicine in reversing end-stage liver failure and cirrhosis. It also serves as a critical warning: antiviral therapy must not be self-discontinued, and ACLF relapse requires immediate access to standardized emergency care with artificial liver support.