Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 5 2022 06 08 316 318 Sara Razdar Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran Seyed Javad Hosseini Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Mohammad Ali Abyazi Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran Mehdi Raei Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Hamed Gholizadeh Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran Mohammad Heiat Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran 2021 08 01 2021 12 26 Acute hepatitis B cases with very high viral load are rare in communities. This study presents an experience of treating a patient suffering from severe acute hepatitis B with a very high viral load. A 38-year-old Iranian male was diagnosed with acute hepatitis B with early and progressive liver dysfunction and a very high viral load. Treatment with Tenofovir was started. The complete response to treatment was achieved with multidisciplinary management; the patient was discharged after a week. A history of not being vaccinated against the hepatitis B virus and the job conditions could be the main causes of increased risks for his illness. However, the high viral load can be considered as the cause of severe acute hepatitis B development. The prompt and accurate diagnosis followed by suitable treatment choice led to the most favorable outcome. https://acta.tums.ac.ir/index.php/acta/article/view/9571