Introduction: Acute liver failure (ALF) is a life-threatening condition that remains challenging for physicians despite several advances in supportive care. Etiologies vary worldwide, with herpes simplex virus (HSV) hepatitis representing less than 1% of cases. Despite its low incidence, ALF is a lethal cause of acute necrotizing hepatitis and has a high mortality. Early antiviral treatment is beneficial for survival and decreased liver transplantation necessity. However, plasmapheresis, despite its theoretical potential benefit, is scarcely reported. Patient concerns: A 25-year-old woman with no known disease presented with painful pharynx ulcers, increased transaminases and impaired liver function. Diagnosis: ALF due to a disseminated HSV-2 primary infection was diagnosed with a positive polymerase chain reaction for HSV-2 in the biopsied liver tissue and blood. Interventions: Empiric antiviral treatment was initiated. After clinical deterioration, plasmapheresis was also initiated. Outcomes: After 6 cycles of plasmapheresis and supportive care, the patient's condition improved without undergoing liver transplantation. Conclusions: ALF is a life-threatening condition, and HSV as an etiology must be suspected based on background, clinical manifestation, and laboratory information. The potential role of plasmapheresis in HSV hepatitis should be considered.

Aims of this study To describe the Latin American population affected by COVID‐19, and to determine relevant risk factors for in‐hospital mortality. Methods We prospectively registered relevant clinical, laboratory, and radiological data of adult patients with COVID‐19, admitted within the first 100 days of the pandemic from a single teaching hospital in Santiago, Chile. The primary outcome was in‐hospital mortality. Secondary outcomes included the need for respiratory support and pharmacological treatment, among others. We combined the chronic disease burden and the severity of illness at admission with predefined clinically relevant risk factors. Cox regression models were used to identify risk factors for in‐hospital mortality. Results We enrolled 395 adult patients, their median age was 61 years; 62.8% of patients were male and 40.1% had a Modified Charlson Comorbidity Index (MCCI) ≥5. Their median Sequential Organ Failure Assessment (SOFA) score was 3; 34.9% used a high‐flow nasal cannula and 17.5% required invasive mechanical ventilation. The in‐hospital mortality rate was 14.7%. In the multivariate analysis, were significant risk factors for in‐hospital mortality: MCCI ≥5 (HR 4.39, P < .001), PaO 2 /FiO 2 ratio ≤200 (HR 1.92, P = .037), and advanced chronic respiratory disease ( HR 3.24, P = .001); pre‐specified combinations of these risk factors in four categories was associated with the outcome in a graded manner. Conclusions and clinical implications The relationship between multiple prognostic factors has been scarcely reported in Latin American patients with COVID‐19. By combining different clinically relevant risk factors, we can identify COVID‐19 patients with high‐, medium‐ and low‐risk of in‐hospital mortality.

BackgroundDiffuse parenchymal pulmonary diseases, called interstitial lung diseases, are a heterogeneous group of disorders that are classified together due to clinical, radiographic, physiological or similar pathological manifestations1.The diagnosis of idiopathic interstitial pneumonias requires the exclusion of known causes of interstitial pneumonia. Identifying an underlying etiology is important for clinical perspectives because it impacts prognosis and treatment2. A recent number of studies has shown that many patients diagnosed as idiopathic interstitial pneumonia have clinical elements that suggest an underlying autoimmune process without meeting established diagnostic criteria for connective tissue disease3,4.ObjectivesOur objectives were characterize the clinical findings of patients who meet the IPAF criteria and compare them with the clinical characteristics of patients with scleroderma-related interstitial lung disease and patients with idiopathic pulmonary fibrosis.MethodsWe retrospectively reviewed 254 patients hospitalized at the Hospital Clínico de La Universidad de Chile between January 2012 and June 2018 who had ICD-10 diagnosis of J.84 (Other respiratory diseases principally affecting the interstitium) and J99.1 (Respiratory disorders in other diffuse connective tissue disorders). The electronic medical record was reviewed retrospectively to extract pertinent data. We applied IPAF criteria to this 254 patients. We then characterized the clinical, serological and morphological features of the IPAF cohort and compared outcomes to other ILD cohorts: scleroderma-related interstitial lung disease and idiopathic pulmonary fibrosis (IPF).Figure 1ResultsOf 254 patients screened, 17 patients met the IPAF criteria. Mean age was 60 years with a female predominance. The most frequent pattern by high-resolution computed tomography was NSIP present in 46.7%. The median of Forced Vital Capacity was 82%, and median of DLCO was 50%. 14 patients (82%) were treated with corticosteroids. 11 Patients (64%) used other immunosuppressant: 6 patients azathioprine, 4 mycophenolate and 1 patient used cyclophosphamide. One patient received a lung transplant in IPAF cohort. We identified 2 deaths in IPAF cohort, 6 in sclerosis systemic and 30 in IPF cohort. IPAF cohort survival was worse than Scleroderma cohort and better than the IPF cohort.ConclusionOur IPAF cohort is similar to the cohorts described in other studies, in relation to the age of diagnostic, female predominance and High-resolution Computed Tomograph pattern. Also the trend in survival was similar to others previously described. Our study have limitations, the first one is related to the retrospective nature of the reviewed cohorts. Further prospective studies should be conducted for a more comprehensive evaluation of the evolution of these diseases and the impact of the treatments used.References[1] Travis, W. (2002). American Thoracic Society/European Respiratory Society Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. ...