A 70-year-old male with alcohol-related liver cirrhosis was admitted with alcoholic hepatitis. Laboratory data indicated nephrotic syndrome with hematuria. Proteinuria was resolved after alcohol abstinence and treatment with diuretics and nutrition therapy. A renal biopsy performed for hematuria demonstrated thrombotic microangiopathy (TMA) showing numerous deposits and endothelial cell dysfunction. The patient was diagnosed with TMA associated with alcoholic liver disease, along with a decreased ADAMTS13 activity and an increased serum level of von Willebrand factor (VWF). Fresh frozen plasma was transfused for the supplementation of ADAMTS13, and recombinant thrombomodulin products (rTM) were administered for thrombolysis. Cases of hematuria with a decreased ADAMTS13 activity or an imbalance in VWF warrant suspicion of TMA, and FFP/rTM should be considered in patients with cirrhosis.

A 49-year-old female with severe jaundice and liver dysfunction was transported to our hospital. Computed tomography revealed a contracted liver and massive ascites. The patient had undergone living-donor liver transplantation. On day 16 post surgery, the liver biopsy was performed to check for acute transplant rejection reaction. As a complication, the patient had intra-abdominal bleeding with shock vital signs; therefore, underwent interventional radiology (IVR) procedures. On day 155 post surgery, she had elevated alanine aminotransferase levels and portal vein regurgitation visible on ultrasonography. Hepatic arteriography showed an intrahepatic arterioportal (AP) shunt near the previous coil embolization. The patient underwent IVR again. This case serves as a reminder to consider AP shunt during differential diagnosis in patients with postoperative liver damage after the liver biopsy.

A 73-year-old woman developed jaundice 2 days after receiving her second dose of the SARS-CoV-2 vaccine (Pfizer-BioNTech). She had positive antinuclear and antismooth muscle antibodies and an elevated serum immunoglobulin G level. A liver biopsy revealed massive necrosis. Since her drug-induced lymphocyte stimulation test for the SARS-CoV-2 vaccine was positive, a diagnosis of drug-induced liver injury was initially suggested. Liver functionality test showed no improvement of her condition and she was started on prednisolone. After her liver functionality test was normal, a follow-up liver biopsy was performed. It revealed portal lymphoplasmacytic infiltration with interface hepatitis and rosette formation, which confirmed the diagnosis of autoimmune hepatitis.

Hepatitis A virus (HAV) can spread among family members through fecal-oral transmission. We report a case of hepatitis A transmission within a family affecting the mother (index case), father, and their three daughters. The viral sequences obtained from the father and two daughters showed a nucleotide similarity ranging from 99.8% to 100%.

Prevention of the intrafamilial transmission of HAV infection requires strict adherence to contact precautions and immunization against HAV after diagnosis of the index case, which should have been considered for this family.