Unlocking the mysteries of fulminant hepatitis: exploring diagnoses in multi-organ disease

Aashika Janwadkar; Laura Kasper; Rebecca Megchelsen; Vishakha Nanda

doi:10.18203/2349-3291.ijcp20251875

Authors

Aashika Janwadkar Department of Pediatrics- Neonatology, John H. Stroger Jr Hospital of Cook County, USA
Laura Kasper Rush University Medical Center
Rebecca Megchelsen Department of Pediatrics- Neonatology, John H. Stroger Jr Hospital of Cook County, USA
Vishakha Nanda Department of Pediatrics- Neonatology, John H. Stroger Jr Hospital of Cook County, USA

DOI:

https://doi.org/10.18203/2349-3291.ijcp20251875

Keywords:

Fulminant hepatitis, Neonate, Acute liver failure

Abstract

A male neonate was born to a mother with a history of scant prenatal care and suspected Herpes lesions in the birth canal. The infant presented after birth with severe anemia, thrombocytopenia, and acute liver failure along with multiple organ involvement. He received multiple transfusions and was treated empirically for potential sepsis and viral infection. Differential diagnoses considered included neonatal HSV infection, enterovirus infection, gestational alloimmune liver disease (GALD), hemophagocytic lymphohistiocytosis (HLH), and inborn errors of metabolism. The case underscores the complexity of diagnosing fulminant hepatitis in neonates and emphasizes the necessity of maintaining a broad differential diagnostic approach. This case report highlights the diagnostic challenges and the need for a systematic approach in managing neonates with fulminant hepatitis.

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Author Biographies

Rebecca Megchelsen, Department of Pediatrics- Neonatology, John H. Stroger Jr Hospital of Cook County, USA

Vishakha Nanda, Department of Pediatrics- Neonatology, John H. Stroger Jr Hospital of Cook County, USA

Attending Physician; Pediatrics, Neonatology Department

References

Bhaduri BR, Mieli-Vergani Gl. Fulminant hepatic failure: pediatric aspects. Semin Liver Dis. 1996;16:349-55. DOI: https://doi.org/10.1055/s-2007-1007248

Danks DM, Campbell PE, Smith AL, Rogers J. Prognosis of babies with neonatal hepatitis. Arch Dis Child. 1977;52:368-72. DOI: https://doi.org/10.1136/adc.52.5.368

Putra J, Ng VL, Perez-Atayade AR. “Pediatric Acute Liver Failure: A Clinicopathological Perspective. Pediatr Dev Pathol. 2022;25:361-79. DOI: https://doi.org/10.1177/10935266211067893

Taylor SA, Whitington PF. Neonatal acute liver failure. Liver Transplantation. 20166;22:677-85. DOI: https://doi.org/10.1002/lt.24433

Pinninti SG, Kimberlin DW. Neonatal herpes simplex virus infections. Semin Perinatol. 2018;42:168-75. DOI: https://doi.org/10.1053/j.semperi.2018.02.004

Samies NL, James SH. Prevention and treatment of neonatal herpes simplex virus infection. Antiviral Res. 2020;176:104721. DOI: https://doi.org/10.1016/j.antiviral.2020.104721

Fidler KJ, Pierce CM, Cubitt WD, Novelli V, Peters MJ. Could neonatal disseminated herpes simplex virus infections be treated earlier. J Infect. 2004;49:141-6. DOI: https://doi.org/10.1016/j.jinf.2004.03.008

Kimberlin DW. Neonatal Herpes Simplex Infection. Clin Microbiol Rev. 2004;17:1-13. DOI: https://doi.org/10.1128/CMR.17.1.1-13.2004

Cantey JB, Sanchez PJ. “Neonatal Herpes Simplex Virus: Past Progress and Future Challenges”. Ped Infect Dis J. 2013;31:1205-7. DOI: https://doi.org/10.1097/INF.0b013e3182a1915e

Ciocca M, Alvarez F. Neonatal acute liver failure: a diagnosis challenge. Arch Argent Pediatr. 2017;115:175-80. DOI: https://doi.org/10.5546/aap.2017.eng.175

Wang LC, Tsai HP, Chen SH, Wang SM. Therapeutics for fulminant hepatitis cause by enteroviruses in neonates. Front Pharmacol. 2012;2:1014823.

Whitington PE. “Neonatal hemochromatosis: a congenital alloimmune hepatitis”. Semin Liver Dis. 2007;27:243-50. DOI: https://doi.org/10.1055/s-2007-985069

Kasko O, Klose E, Rama G, Newberry D, Jnah A. “Gestational Alloimmune Liver Disease: A Case Study”. Neonatal Netw. 2018;37:271-80. DOI: https://doi.org/10.1891/0730-0832.37.5.271

Roumianstev S, Shah U, Westra SJ, Misdraji J. Case Records of the Massachusetts General Hospital. Case 20-2015. A Newborn Girl with Hypotension, Coagulopathy, Anemia, hyperbilirubinemia” N Engl J Med. 2015;25:2442-53. DOI: https://doi.org/10.1056/NEJMcpc1404334

Najib K, Moghtaderi M, Bordbar M, Monabati A. Awareness of Hemophagocytic Lymphohistiocytosis as an Unusual Cause of Liver Failure in the Neonatal Period. J of Pediatr Hemat/Onc. 2022;42:479. DOI: https://doi.org/10.1097/MPH.0000000000001600

Hegarty R, Hadzic N, Gissen P, Dhawan A. Inherited metabolic disorders presenting as acute liver failure in newborns and young children: King’s College Hospital experience. Eur J Pediatr. 2015;174:1387-92. DOI: https://doi.org/10.1007/s00431-015-2540-6

Chung WK, Roberts TPL, Sherr EH, Green Snyder LA, Spiro JE: 16p11.2 deletion syndrome. Current Opin Gene Dev. 2021;16:68. DOI: https://doi.org/10.1016/j.gde.2021.01.011

Hanson E, Nasir RH, Fong A, Lian A, Hundley R, Shen Y, et al. Cognitive and Behavioral Characterization of 16p11.2 Deletion Syndrome. J of Devel & Behav Pediatrics. 2010;31:649-57. DOI: https://doi.org/10.1097/DBP.0b013e3181ea50ed