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Acute encephalopathy with liver dysfunction, chylous ascites and cytomegalovirus infection
Insights
Cytomegalovirus (CMV) infection may cause acute encephalopathy and liver dysfunction in children. This case links CMV to acute chylous ascites due to lymphatic obstruction from mesenteric lymphadenitis.
Area of Science:
- Pediatric Infectious Diseases
- Hepatology
- Gastroenterology
Background:
- Cytomegalovirus (CMV) is a common viral infection that can cause significant illness in children.
- Acute encephalopathy and liver dysfunction are serious conditions that require prompt diagnosis and management.
- Chylous ascites, the accumulation of lymphatic fluid in the abdominal cavity, can have various underlying causes.
Observation:
- A child presented with symptoms of acute encephalopathy and liver dysfunction.
- During the illness, the child developed acute chylous ascites.
- Cytomegalovirus (CMV) infection was confirmed through increased antibody titers and viral isolation from urine.
Findings:
- This case is the first to suggest a possible link between cytomegalovirus (CMV) infection and acute encephalopathy and liver dysfunction in a pediatric patient.
- A lymphangiogram revealed enlarged abdominal lymph nodes causing severe obstruction of lymphatic flow.
- The obstruction led to the transudation of lymph into the peritoneal cavity, resulting in acute chylous ascites.
Implications:
- The findings suggest that cytomegalovirus (CMV) infection should be considered in the differential diagnosis of children presenting with acute encephalopathy, liver dysfunction, and chylous ascites.
- Early identification and management of CMV infection may be crucial in preventing or mitigating complications like chylous ascites.
- Further research is warranted to elucidate the precise mechanisms by which CMV may contribute to lymphatic obstruction and chylous ascites in children.
Abstract:
A child with acute encephalopathy and liver dysfunction subsequently developed acute chylous ascites. Titers for cytomegalovirus increased from less than 1:2 to 1:32 during the illness, and cytomegalovirus was isolated from the urine. The case is the first one possibly linking cytomegalovirus and acute encephalopathy and liver dysfunction in a child. In our patient, enlargement of the abdominal lymph nodes, as seen on a lymphangiogram, resulted in a severe obstruction of abdominal lymphatic flow, producing a transudation of lymph into the peritoneal cavity. The acute chylous ascites associated with mesenteric lymphadenitis was likely caused by the cytomegalovirus infection.