Acute liver failure, autoimmune hepatitis, and leptospirosis: a case report

Area of Science:

• Pediatric Hepatology
• Infectious Diseases
• Autoimmune Disorders

Background:

• Acute liver failure (ALF) in children presents with diverse etiologies, commonly including viral hepatitis, drug toxicity, and environmental toxins.
• Identifying the underlying cause of pediatric ALF is crucial for timely and appropriate management.
• Autoimmune hepatitis (AIH) is a recognized cause of ALF, but less common than other etiologies.

Observation:

• This report details a rare case of a child presenting with acute liver failure.
• The patient was diagnosed with autoimmune hepatitis.
• Leptospirosis infection was identified as the underlying trigger for the autoimmune hepatitis and subsequent acute liver failure.

Findings:

• Leptospirosis, an infectious disease usually associated with other clinical manifestations, can uncommonly lead to autoimmune hepatitis and acute liver failure in pediatric cases.
• The diagnostic workup confirmed leptospirosis as the etiology, despite its infrequent association with AIH and ALF.
• This case underscores the importance of considering infectious etiologies, even rare ones, in the differential diagnosis of pediatric ALF.

Implications:

• Clinicians should consider leptospirosis in the differential diagnosis of pediatric acute liver failure, particularly when autoimmune hepatitis is suspected.
• This case expands the known spectrum of leptospirosis-associated liver injury.
• Further research may elucidate the mechanisms by which leptospirosis can trigger autoimmune responses leading to liver failure in susceptible children.