Co-presentation of diabetic ketoacidosis and hepatitis an infection with anasarca: a case report
DOI:
https://doi.org/10.18203/2349-3291.ijcp20250107Keywords:
Anasarca, Co-presentation, Diabetic ketoacidosis, Hepatitis A, Respiratory distressAbstract
Diabetic ketoacidosis is the common initial presentation of Type 1 Diabetes Mellitus in paediatric practice. Hepatitis A infection is a common cause of jaundice in children with varied constitutional symptoms. However, co-presentation of diabetic ketoacidosis and hepatitis A infection with anasarca is rare. One four-year-ten-month-old male child presented to the emergency department of our hospital with diabetic ketoacidosis with new-onset Type 1 diabetes mellitus. At the time of presentation, the blood sugar level was in the diabetic range, 677 mg% laboratory value and was suggestive of diabetes mellitus. The HbA1c level was 14.47% at that time; however, there was no history of the classical triad of polyuria, polydipsia and polyphagia in the child. The child presented with mild acidosis (pH 7.3) and responded to the Milwaukee regimen of DKA management. During the course of the management, the child developed clinical jaundice on the 5th day of hospital admission and was investigated and diagnosed as having viral hepatitis A. On the 7th day of illness, the child developed anasarca in the form of moderate pleural effusion and gross ascites, leading to respiratory distress along with pedal edema and scrotal edema. The anasarca responded to symptomatic treatment and the clinical improvement of Hepatitis A occurred after 15 days. The stressful event of brewing hepatitis A, precipitating DKA in a relatively asymptomatic child of type 1 diabetes mellitus, is more likely in our case. The chance association of both the conditions in an underweight child with a history of 3rd degree consanguinity is noted in our child. The child also developed anasarca, which is uncommon in viral hepatitis A or diabetic ketoacidosis alone.
Metrics
References
Chowdhury A Rare Association of Hepatitis A Virus Infection with Type-1 Diabetes Clin Pract. 2016;4;6(2):844. DOI: https://doi.org/10.4081/cp.2016.844
El-Serag HB, Everhart JE. Diabetes increases the risk of acute hepatic failure. Gastroenterology 2002;122:1822-8. DOI: https://doi.org/10.1053/gast.2002.33650
Hwang YC, Jeong IK, Chon S. Fulminant type 1 diabetes mellitus associated with acute hepatitis A. Diabet Med. 2010;27:366-7. DOI: https://doi.org/10.1111/j.1464-5491.2010.02930.x
Atabek ME, Kart H, Erkul I. Prevalence of hepatitis A, B, C and E virus in adolescents with type-1 diabetes mellitus. Int J Adolesc Med Health. 2003;15:133-7. DOI: https://doi.org/10.1515/IJAMH.2003.15.2.133
Vesely DL, Dilley RW, Duckworth WC, Paustian FF. Hepatitis A-induced diabetes mellitus, acute renal failure and liver failure. Am J Med Sci. 1999;317:419-24. DOI: https://doi.org/10.1016/S0002-9629(15)40557-9
Makeen AM. The association of infective hepatitis type A (HAV) and diabetes mellitus. Trop Geogr Med. 1992;44:362-4.
Gallagher E, Siu HY. Diabetic ketoacidosis as first presentation of type 1 diabetes mellitus in a young child: Important differential diagnosis for respiratory distress. Canadian Family Physician. 2020;66(6):425-6.
Souza LC, Kraemer GD, Koliski A, Carreiro JE, Cat MN, Lacerda LD, et al. Diabetic ketoacidosis as the initial presentation of type 1 diabetes in children and adolescents: epidemiological study in southern Brazil. Revista Paulista de Pediatria. 2019;38:2018204. DOI: https://doi.org/10.1590/1984-0462/2020/38/2018204
Shaltout AA, Channanath AM, Thanaraj TA, Omar D, Abdulrasoul M, Zanaty N, Almahdi M, Alkandari H, AlAbdulrazzaq D, d’Mello L, Mandani F. Ketoacidosis at first presentation of type 1 diabetes mellitus among children: a study from Kuwait. Scientific reports. 2016;6(1):27519. DOI: https://doi.org/10.1038/srep27519
Murlidharan S, Sangle AL, Engade M, Kale AB. The clinical profile of children with hepatitis A infection: an observational hospital-based study. Cureus. 2022;14(8):45. DOI: https://doi.org/10.7759/cureus.28290
Fouad HM, Reyad EM, El-Din AG. Acute hepatitis A is the chief etiology of acute hepatitis in Egyptian children: a single-center study. European J of Clin Microbiology & Infectious Diseases. 2018;37(10):1941-7. DOI: https://doi.org/10.1007/s10096-018-3329-0
Kelgeri C, Couper M, Gupte GL, Brant A, Patel M, Johansen L, et al. Clinical spectrum of children with acute hepatitis of unknown cause. New England J of Med. 2022;387(7):611-9. DOI: https://doi.org/10.1056/NEJMoa2206704
Fawzy D, Elgebaly A. A management challenge of Acute viral hepatitis A in a child presented with DKA as a first presentation. Inh Res Paed. 2019;91:539.
A Rare Association of Hepatitis A Virus Infection with Type-1 Diabetes Available at: https://pmc.ncbi.nlm.nih.gov/articles. Accessed on 21 August 2024.