Grand Rounds

Hepatic Encephalopathy due to Hepatitis A – Can age predict need for liver transplant?


Kruti Dhaval Gandhi1, Ira Shah2
1Seth G S Medical College, Mumbai, India, 2Pediatric GI and Hepatology, Levioza Health Care, Mumbai, India

Address for Correspondence: Kruti Dhaval Gandhi, 501, Crescent Heights, Forjett Street, Mumbai- 400036, Maharashtra, India. Email: krutig96@gmail.com


Keywords: Hepatitis A, Hepatic Encephalopathy

Clinical Problem:
Case 1
An 8-year-old female child presented with fever and lethargy for 8 days, right hypochondriac pain and abdominal distension for 5 days, vomiting for 3 days, oliguria and irrelevant speech for 2 days. There was no hematemesis, jaundice, or bleeding from any site. On examination, she was icteric, had anasarca with altered sensorium with blood pressure 98/60 mm of Hg. There was no hepatosplenomegaly, meningeal signs, or focal neurological deficit. Other systems were normal. Investigations showed hemoglobin of 11 gm/dl, white blood cell (WBC) count of 8400/cumm, platelets of 1,71,000/cumm, bilirubin of 4.4 mg/dl, SGOT of 2890 IU/L, SGPT of 4215 IU/L, total proteins of 5.7 gm/dl, albumin of 2.7 gm/dl, prothrombin time (PT) of 39 sec, partial thromboplastin time (PTT) of 93.3 sec and ammonia of 300 mg/dl. Her Hepatitis A IgM was positive. HBsAg, Anti hepatitis C virus (HCV), leptospira IgM, dengue IgM was negative. Ultrasound abdomen showed moderate ascites with right sided pleural effusion. The child was treated with dextrose, lactulose, metronidazole, and L-ornithine-L-aspartate following which she gradually improved and recovered.

Case 2
An 8-year-old male child presented with abdominal pain for 7 days, jaundice for 4 days, increased sleepiness for 2 days. There was edema or no bleeding from any site. On examination, he had icterus, hepatomegaly, ascites. There were no meningeal signs or focal neurological deficit. Other systems were normal. Investigations showed hemoglobin of 8.2 gm/dl, WBC of 5500/cumm, platelets of 2,25,000/cumm, bilirubin of 18.13 mg/dl, SGOT of 352 IU/L, SGPT of 713 IU/L, total proteins of 7.0 gm/dl, albumin of 3.6 gm/dl, PT of 12 sec, PTT of 23.8 sec. His Hepatitis A IgM was positive. HBsAg, Anti HCV, Leptospira IgM, Dengue IgM were negative. The child was treated with intravenous (IV) fluids, lactulose and L-ornithine-L-aspartate following which he gradually improved and recovered.

Can age predict need for liver transplant in children with Hepatitis A virus infection?


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