Diagnostic Dilemma


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.

Is this neonatal hepatitis due to Hepatitis B _?
Expert Opinion :
This child`s neonatal cholestasis resolved on its own. His HBsAg at 6 months of age was negative. Thus Hepatitis B was not the cause of neonatal cholestasis.
Answer Discussion :
Cesar Antonio Ortega
This presentation is most consistant with congenital Rubella given IUGR.
10 years ago
Hepatitis b infection
10 years ago

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