Therapeutic Plasma Exchange as Salvage Therapy in Paediatric Fulminant Hepatitis A Complicated by Acute Kidney Injury and Multidrug-Resistant Pneumonia: A Case Report

Although hepatitis A virus infection is mostly self-limited, it can rarely cause acute fulminant liver failure, especially in resource-limited settings where emergency liver transplant is unavailable.We present the case of a 14-year-old girl diagnosed with acute fulminant hepatitis A complicated by severe hepatic encephalopathy (Glasgow Coma Scale (GCS)-2T/10), acute kidney injury (AKI), and ventilator-associated pneumonia (VAP).On admission, the patient required mechanical ventilation and intensive supportive care.Due to rapidly worsening coagulopathy (international normalized ratio (INR): 4.39) and profound hyperammonaemia (391 µmol/L), she underwent three sessions of therapeutic plasma exchange (TPE) alongside targeted broad-spectrum antimicrobial therapy.Marked clinical and metabolic improvement was observed post-TPE, culminating in the full recovery of hepatic and renal function and total resolution of her encephalopathy.She was successfully discharged with normal organ function.This case emphasizes the critical value of early diagnosis and aggressive multidisciplinary management and highlights the effective role of TPE as a temporary metabolic bridge during the critical phase of illness to spontaneous recovery in selected cases of paediatric fulminant hepatic failure (FHF), enabling survival without liver transplantation even amidst severe multiorgan dysfunction.