Case Report

Acute liver failure in a four-year-old child with relapse of hepatitis A

Valeri Velev1, Metodi Popov1, Iskren Kaftandjiev2, Rumen Harizanov2
1Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases, Sofia, Bulgaria, Clinic of pediatric infectious diseases
2National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria, Department of Parasitology and Tropical Medicine

Worldwide Medicine 2019; 1(2): 24-28 | DOI: 10.5455/ww.41595      PDF


Abstract


Hepatitis A is one of the most common liver diseases among children worldwide and as such is the most common cause of acute liver failure (ALF) among them. Relapse may occur in 3 to 20% of the patients with acute hepatitis A, and in less than 0.5% of the cases it can cause a life-threatening complication such as acute hepatic failure. With this report, we describe a rare case of recurrence of hepatitis A in a four-year-old child with subsequent development of acute liver failure. A 35 days after treatment for acute hepatitis A and hospital discharge, the child was hospitalized again with nausea, persistent vomiting, darkening of the urine, and a prominent jaundice. Laboratory data were indicative for a recurrence of the disease. On the second day, the child became somnolent, falling asleep while eating, right-sided Babinski sign appeared. The treatment with ademetionine continued intravenously and to the therapy were added mannitol, cefoperazone, isogroup plasma infusion, vitamin K and oxygen. Within 5 days the signs of precoma gradually resolved, as the child recovered its activity and the neurological symptoms abated. Due to the lack of etiological treatment of hepatitis A and the severe course with high mortality rate of ALF, early detection of the onset of ALF and timely initiation of intensive care are needed. It must be considered the importance of hepatitis A vaccine as one of the most valuable preventive measures against possible development of ALF as a complication in the course of the disease.
Keywords: Acute liver failure; hepatitis A; hepatitis A vaccine