Two male homosexual patients, one an intravenous (IV) drug abuser, had hepatitis B surface antigen-positive fulminant hepatitis. On the basis of tests for IgM antibody to hepatitis B core antigen (HBcAg) and for IgM and IgG antibodies to delta agent, acute delta hepatitis in chronic hepatitis B infection was diagnosed. The delta agent appeared to have a role in producing fulminant hepatic failure. Accurate diagnosis of fulminant hepatitis may be impossible without recourse to tests for IgM antibody to HBcAg and antibodies to delta agent. Although delta hepatitis in the United States primarily affects IV drug abusers, this infection can also occur in male homosexuals.
De Cock KM, Govindarajan S, Redeker AG. Fulminant Delta Hepatitis in Chronic Hepatitis B Infection. JAMA. 1984;252(19):2746–2748. doi:10.1001/jama.1984.03350190048018
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