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Cholestatic jaundice with urinary tract infection in a child with acute lymphoblastic leukaemia
1Department of Paediatrics, Dhahran Health Centre, Saudi Arabia.
Insights
Cholestatic jaundice associated with urinary tract infections is rare in older children. This case highlights a 4-year-old with leukemia who recovered after antibiotic treatment for a UTI, showing normal liver enzymes.
Area of Science:
- Pediatrics
- Hepatology
- Infectious Diseases
Background:
- Cholestatic jaundice with urinary tract infection (UTI) is primarily observed in neonates and infants under two months.
- This syndrome is attributed to immature liver function and sensitivity to bacterial endotoxins in young infants.
- Similar presentations occur in adults with severe non-hepatic bacterial infections, but are rare in older children.
Observation:
- A 4-year-old girl diagnosed with acute lymphoblastic leukemia (ALL) presented with cholestatic jaundice.
- Her liver enzymes were normal or only slightly elevated.
- She also had a concurrent urinary tract infection.
Findings:
- Antibiotic treatment for the UTI led to the resolution of cholestatic jaundice.
- The patient tolerated potentially hepatotoxic leukemia treatments without complications.
- This contrasts with reported adult cases of acute leukemia with non-hepatic bacterial infection and cholestatic jaundice, which had poor outcomes.
Implications:
- This case expands the understanding of cholestatic jaundice associated with UTIs in older pediatric populations.
- It suggests that prompt antibiotic treatment can effectively manage this syndrome in children, even those with underlying conditions like leukemia.
- Further research is warranted to elucidate the mechanisms and optimize management strategies for this rare presentation.
Abstract:
The syndrome of cholestatic jaundice in association with urinary tract infection with normal or slightly elevated liver enzymes has been reported mainly in newborns and infants below 2 months of age. The relative immaturity of the infant's liver and its sensitivity to bacterial endotoxins may explain the occurrence of this syndrome in this age group. A similar syndrome has been reported in adults with severe non-hepatic bacterial infection, including some with urinary tract infection. However, only three case reports in older children could be found. In this report, the case of a 4-year-old girl with acute lymphoblastic leukaemia, who presented with cholestatic jaundice with normal liver enzymes and urinary tract infection, is described. Treatment with antibiotics resulted in resolution of the jaundice and potentially hepatotoxic drugs were used for the treatment of leukaemia with no problems. Two adult patients with acute leukaemia, non-hepatic bacterial infection and cholestatic jaundice have been reported; both died shortly after diagnosis.