Diagnostic Dilemma - Pediatric Oncall
Author: Pediatric Oncall
A one month old boy born of non consanguineous marriage presented with jaundice without clay coloured stools for 3 days. Mother was a chronic carrier of Hepatitis B and had jaundice at 18 years of age. There were no antenatal or post natal complications. On examination, height was 42 cms, weight was 1.75 kg. There was jaundice and hepatomegaly. Others systems were normal. Investigations showed:
• Hemoglobin = 9.5 gm, dl
• WBC = 18,000, cumm
• Platelets = 3,75,000, cumm
• Bilirubin = 15.2 mg, dl {direct bilirubin = 3.2 mg, dl}, SGOT = 106 IU, L, SGPT = 44 IU, L, Total proteins = 7 gm, dl, Albumin = 4.3 gm, dl, Alkaline phosphatase = 293 IU, L.
• PT and PTT = deranged
• TORCH = CMV, Rubella IgG positive
• HIV, Hepatitis C antibody = Negative
• Ophthalmological examination, Hearing test = Negative
• USG Abdomen = Gall bladder seen
• Urine reducing substance = Negative
• Echocardiography = Normal

The baby was given Hepatitis B vaccine and Hepatitis B immunoglobulin within 72 hours of birth.
Answers of this discussion
Author :- ammar alyousef on 06 July 2013.
Answer :- Yes even the possibility of hepatitis B virus trans placental transmission is rare, IEM should be excluded

Author :- anupama agarwal on 08 July 2013.
Answer :- not hepB.torch infection

Author :- Kalpana Shete on 12 July 2013.
Answer :- n0n hepatitis torch infection

Author :- SERAFINCERANU NAKISA on 21 July 2013.
Answer :- This is the infectios icter { rubella was poztive} because of hemolytic consciences

Author :- rehan rafat on 21 July 2013.
Answer :- Could be IEM

Author :- jahanara gul on 21 July 2013.
Answer :- Keeing in view the TORCH serology and baby being severely IUGR with hepatitis so TORCH infection should be put 1st in the D, D

Author :- Mustafa Aydin on 21 July 2013.
Answer :- How is hepatitis B markers_? AntiHBc IgM_? {window period} And also, Because patient seems IUGR or malnourished, the genetic and metabolic causes {e.g. alpha1 tyripsin deficiency, tyrosinemia, Niemann-Pick disease} should be excluded.

Author :- D Y Shrikhande on 21 July 2013.
Answer :- likely

Author :- Kathleen Braico on 21 July 2013.
Answer :- One would assume that since the other elements of TORCH were done, so was the Hep B titer...He could have postnatally acquired Hep B, or Hep A for that matter. Why is he so small_? What was his birth weight_? We are not told if he was breast fed or has a history of diarrhea.

Author :- Ashu syal on 21 July 2013.
Answer :- Well there r two components to this query: 1} indirect hyperbilirubinemia with abnormal coags:- indicating the baby is hemolyzing. And 2} increased LFTs with hepatomegaly. I think we are dealing with some kind of blood dyscrasias! G6PD deficiency in newborn Csn result in prolonged jaundice. Also need to rule out- if mom is breast feeding and taking Meds like phenobarbital etc.

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