Diagnostic Dilemma


A 3 months old boy born of non consanguineous marriage presented with bilateral conjunctivitis, diarrhea and vomiting 10 days ago that resolved in next 2 days` progressive abdominal distension and fever for 4-5 days. There was no jaundice. On examination, he had ascitis with hepatomegaly but no icterus. Other systems were normal. Initial investigations showed normal bilirubin with SGOT of 10,075 IU, L and SGPT of 3504 IU, L with hemoglobin of 10.9 gm, dl, WBC count of 5000, cumm and platelets of 54,000, cumm. Both prothrombin time and partial thromboplastin time were deranged. USG Abdomen with colour doppler showed moderate hepatomegaly and ascitis with patent portal veins and hepatic veins and CT angiography of portal system and inferior vena cava was normal. The child required repeated paracentesis in view of rapidly filling ascitis and gradually bilirubin also started rising with a shrinking liver and rapidly decreasing liver enzymes with altered sensorium.

What is the cause of fulminant hepatic failure with initial no jaundice_?
Expert Opinion :
The child had not received Paracetamol currently. Thus Paracetamol poisoning seems to be unlikely though the presentation is very similar.
In view of anicteric hepatitis initially with progressive fulminant hepatic failure, a metabolic disorder was considered.
Budd Chiari was ruled out as the doppler was normal and even CT angio was normal.
Answer Discussion :
vikas natu
paracetamol Induced_?
9 years ago
kotha satish
Reyes encephalopathy
9 years ago

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