• Junjun Wu, Jin Yu, Huaming Li, Yufang Wang, and Rong Xu.
• Department of Gastroenterology, Hangzhou Third People's Hospital, Hangzhou, China.
• Medicine (Baltimore). 2024 Oct 25; 103 (43): e40103e40103.

RationaleElderly patients with acute liver failure are highly susceptible to severe complications, such as invasive fungal infections, due to weakened immune systems and altered gut microbiota. A thorough understanding of liver failure and opportunistic infections is crucial for effective management.Patient ConcernsAn 84-year-old male with acute liver failure from hepatitis E experienced worsening jaundice despite standard treatments. He also developed respiratory symptoms, including blood-streaked sputum, raising concerns about a potential fungal infection.DiagnosesThe patient was diagnosed with acute liver failure secondary to hepatitis E and an invasive fungal infection caused by Aspergillus fumigatus. Initial treatments included artificial liver plasma exchange and antifungal prophylaxis. Further diagnostics, including bronchoscopy and next-generation sequencing of alveolar lavage fluid, confirmed the Aspergillus infection.LessonsElderly liver failure patients are particularly prone to opportunistic infections, underscoring the need for vigilant monitoring and early intervention. Despite aggressive treatments, including antifungal therapy and artificial liver support, prognosis remains poor, highlighting the importance of prompt diagnosis and comprehensive management to enhance patient outcomes.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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