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Articular and cutaneous prodromal manifestations of viral hepatitis
Insights
Viral hepatitis in children can present with a serum sickness-like illness (SSLI) involving arthritis, arthralgia, and rash. This SSLI often precedes liver involvement and may indicate a need for hepatitis diagnosis.
Area of Science:
- Pediatrics
- Hepatology
- Rheumatology
Background:
- The association of arthritis, arthralgia, and skin rashes as a prodrome to viral hepatitis is recognized in adults but less described in children.
- Serum sickness-like illness (SSLI) can precede overt liver disease.
Purpose of the Study:
- To describe the presentation of viral hepatitis in children manifesting as a serum sickness-like illness.
- To highlight the diagnostic considerations for viral hepatitis in pediatric patients presenting with SSLI.
Main Methods:
- Case series over an 18-month period.
- Clinical and biochemical evaluation of three pediatric patients.
- Detection of Hepatitis B surface antigen (HBsAg) and serum complement levels.
Main Results:
- Three children presented with SSLI preceding evident liver involvement.
- Prodromal symptoms occurred up to four weeks before hepatitis diagnosis.
- SSLI symptoms generally subsided as liver disease became apparent.
- Hepatitis B surface antigen (HBsAg) was detected in two patients; free antibody was not.
- Low serum complement levels were observed during the prodromal phase, normalizing with liver involvement.
Conclusions:
- Viral hepatitis should be considered in children with unexplained polyarthritis, polyarthralgia, and rash (SSLI).
- SSLI can be an early indicator of viral hepatitis in pediatric populations.
- Monitoring complement levels may aid in diagnosis during the prodromal phase.
Abstract:
The association of arthritis, arthralgia, and various types of skin rashes, as a prodrome to viral hepatitis, although well recognized in adults, has not been well described in children. In an 18-month period, three children presented with this serum sickness-like illness before the onset of evident liver involvement. In one case, the prodromal symptoms occurred four weeks before biochemical or clinical evidence of hepatitis. The SSLI tended to subside with the onset of clinically evident liver disease. Hepatitis B surface antigen (HBsAg, Australia antigen) was detected in the sera of two patients, but free antibody to the antigen was not demonstrable in either one. Serum complement levels were low during the prodromal phase and tended to return to normal value at the onset of extensive liver involvement. The diagnosis of viral hepatitis should be considered in children presenting with polyarthritis, polyarthralgia, and a rash (serum sickness-like illness) of uncertain etiology.