We present a case of a 5-month-old infant with acute liver failure caused by vertically transmitted hepatitis B virus genotype C, despite intensive treatment with tenofovir disoproxil fumarate and supportive care. The infant exhibited rapid progression, with high hepatitis B virus DNA levels and poor response to treatment, leading to death. Genetic sequencing revealed shared mutations in the reverse transcriptase and surface hepatitis B proteins between the mother and child, indicating vertical transmission. Despite multiple mutations, the virus remained sensitive to antiviral drugs. Early initiation of antiviral therapy may be critical, as delayed treatment worsened the outcome in this case. Strengthening prenatal hepatitis B virus screening and vaccination is essential to prevent mother-to-child transmission and reduce hepatitis B virus-related liver failure in infants.
Ly et al. (2026) studied this question.