Acute-on-chronic liver failure following pneumonia in an elderly woman with metabolic dysfunction-associated steatotic liver cirrhosis.

The number of patients with acute-on-chronic liver failure (ACLF) from metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing, and its aging cohort is experiencing increasing mortality. In general, it is more difficult to manage elderly patients with ACLF. Here, we described a case of prolonged ACLF triggered by pneumonia in a woman in her 80s who had MASLD-associated cirrhosis. Although she developed both spontaneous bacterial peritonitis and aspiration pneumonia during the course of her first admission to our department, she recovered with intensive care provision, including steroid treatment and antibiotics for acute respiratory failure. She was discharged from our hospital on Day 45. Age is one of the important factors influencing prognosis, indicating that elderly patient with ACLF seems to exhibit a poor prognosis. Her infection events were adequately controlled, which seemed to benefit for her survival. In conclusion, we confirm that appropriate treatments without liver transplantation may lead to a better prognosis in patients with ACLF, even among elderly patients.