Successful treatment of acute-on-chronic liver failure and hemolytic anemia with hepato-protective drugs in combination with intravenous ozone without steroids: A case report

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Both acute-on-chronic liver failure (ACLF) and autoimmune hemolytic anemia (AIHA) are common causes of jaundice. A co-occurrence of ACLF and AIHA is rare in clinical practice. This report describes a male elderly patient who developed persistently increased levels of total bilirubin and ascites after endoscopic retrograde cholangiopancreatography for the successful treatment of common bile duct stones. Eventually, he was diagnosed with ACLF and AIHA according to current diagnostic criteria. The patient was given conventional hepato-protective drugs, human albumin, and diuretics in combination with immune ozone without steroids, and he responded well. The therapeutic role of immune ozone in this case is also discussed. When immune ozone was given, total bilirubin gradually decreased; however, no change in total bilirubin was observed after immune ozone was stopped. Notably, when immune ozone was re-initiated, total bilirubin decreased again.