Abstract We report the case of a 37 year old woman who came to the hospital because of jaundice and a fever. Her V\PSWRPVZHUHDVVRFLDWHGZLWKVLJQL?FDQWOLYHULPSDLUPHQWDQGDQHFURLQADPPDWRU\SDWWHUQGXHWRYLUDOhepatitis B although she had no relevant medical history. Her symptoms developed rapidly until death. We SUHVHQWWKHIDFWRUVWKDWPD\KDYHLQAXHQFHGKHUSURJUHVVLRQWRIXOPLQDQWOLYHUIDLOXUHDVGHVFULEHGLQWKHliterature. Keywords Acute liver failure, causes of hepatitis B, hepatitis B virus, hepatitis B viral mutations, hepatitis B therapy. Case report INTRODUCTION Fulminant hepatic failure is a severe and acute injury which presents infrequently. It is probably related to or induced by an exaggerated immune response to viral hepatitis, or as described in most of the series, to acetaminophen poiso-ning and acute liver necrosis.It is typically described as encephalopathy occurring after a prolonged time (INR> 1.5). Depending on the amount of time of evolution between symptoms and the development of encephalopathy, it is classified into either hyperacute, acute or subacute types.Since it is a rare entity, there are no large-scale studies describing its natural history, or level of evidence for mana -gement. Nevertheless, in 2011 the American Association for the Study of Liver Diseases (AASLD) presented a back -ground review of expert opinions of the document publis-hed in 2005 regarding diagnosis, treatment and transplant expectations.With this article, we want to put constraints in the early diagnosis of the etiology of liver failure, as well as its proper handling, in context. In addition, we briefly review the sub -ject with emphasis on factors that influence the evolution of hepatitis B infections into fulminant hepatic failure.