AKT INDUCED FULMINANT HEPATIC FAILURE

Author: Pediatric Oncall

Question
A 20 months old girl presented with jaundice for 1½ months and bleeding per rectum one episode. There was no hematemesis. She had edema all over body for past 3 days and altered sensorium for one day. Patient had been started on 2 drug antituberculosis treatment {ATT} consisting of Isoniazid {H}, Rifampicin {R} in view of a positive Mantoux test with normal Chest X-Ray 3 months ago. Child developed jaundice on 2nd month of ATT itself but ATT was continued by the physician till she developed edema following which it was stopped. On examination, she was altered, had jaundice, anasarca. Her liver was 3 cms palpable which subsequently was not palpable. Other systems were not palpable. Other systems were normal. Investigations are depicted as follows:
Patient was treated with fresh frozen plasma, lactulose, Metronidazole and L-ornithine-L-aspartate. Patient gradually improved after 30 days and bilirubin decreased to 7 mg, dl and SGOT decreased to 352 IU, L, SGPT decreased to 142 IU, L with Albumin of 3.4 gm, dl. Patient was followed up for 6 months but continued to have coarse echotexture of liver with SGOT of 72 IU, L, SGPT of 65 IU, L and bilirubin of 0.5 mg, dl.