Cigarette marketing in Senegal, West Africa

We report the case of a patient admitted to the hospital with psychiatric troubles. Soon after admission, he presented severe hepatitis of unknown origin. Careful review of the charts, transvenous liver biopsy, right heart and hepatic pressure measurements, negative toxicologic and viral screenings were highly suggestive of hypoxic hepatitis. Indeed, the patient had previously been treated for a decompensated cardiomyopathy and medications stopped prior to the current admission. Without clear clinical evidence of heart failure he presented a brief malaise two days before the increase in liver enzymes. Holter heart recording showed afterwards bouts of ventricular tachycardia. Treatment with Dobutamine and antiarrythmics led to a rapid decrease of transaminase levels and recovery in liver function. Unfortunately, he died three weeks later from his cardiomyopathy. This case illustrates the need for cardiovascular work-up in the context of hepatitis from unknown origin.