Fatal, acute non-A, non-B hepatitis with confluent necrosis. Case report and proposal for diagnostic work-up.

We are reporting a fatal case of acute Non-A, Non-B (NANB) hepatitis with massive liver destruction in a 58-year-old woman. NANB hepatitis is still a diagnosis by exclusion, and detailed knowledge of the endemic diseases associated with hepatitis in a given geographic area should be included in the diagnostic work-up. In Lebanon, where 97% of the adult population has anti-HAV in their sera, the IgM fraction of anti-HAV must be determined in order to differentiate between previous exposure to HAV and an active infection. Q fever, an endemic disease in this area, should be also ruled out before the diagnosis of NANB hepatitis is established.