Hepatitis A is generally known as a mild, self-limiting disease of the liver, but in rare instances it can progress to fulminant hepatitis, which may require liver transplantation for recovery. Such cases are known to be related to old age and underlying liver disease. We report four cases of hepatitis A in which patients presented with fulminant hepatitis and acute renal failure and underwent liver transplantation. The following common features were observed in our cases: (1) occurrence in relatively old age (≥39 years old), (2) association with acute renal failure, (3) presence of hepatomegaly, and (4) microscopic features of sub-massive hepatic necrosis. (Korean J Hepatol 2009;15:362-369)
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