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Human Parechovirus as a Cause of Isolated Pediatric Acute Liver Failure
Amee M Bigelow1, John P Scott2,3, Johnny C Hong4
1Departments of Pediatrics, Critical Care Section, abigelow@mcw.edu.
Insights
Human parechovirus (HPeV) infection is linked to acute liver failure in infants, a rare cause of this condition. This case highlights HPeV as a potential trigger for liver failure and subsequent gastrointestinal complications post-transplant.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Virology
Background:
- Acute liver failure (ALF) in infants often has an indeterminate cause, with viral infections rarely identified.
- Human parechovirus (HPeV) is an emerging pathogen, but its role in pediatric ALF is not well-established.
Observation:
- A 10-month-old infant presented with fussiness and rapidly progressive liver dysfunction and coagulopathy, necessitating a liver transplant.
- Extensive diagnostic workup for genetic, autoimmune, and common infectious causes of ALF was negative.
- Serum analysis revealed a positive RNA test for human parechovirus type 3 (HPeV-3).
Findings:
- This case represents the first reported instance of isolated ALF in an infant attributed to HPeV infection.
- The infant experienced post-liver transplant complications, including ileal-ileal and jejunal intussusceptions, potentially linked to HPeV.
Implications:
- This case underscores the importance of comprehensive viral testing in pediatric ALF, as current protocols may be incomplete.
- Clinicians should consider HPeV as a potential cause of ALF and be vigilant for delayed gastrointestinal complications, such as intussusception, in the post-transplant period.
- Routine HPeV testing could improve the understanding of its clinical spectrum and outcomes in pediatric liver disease.
Abstract:
Among infants, almost half of acute liver failure cases are classified as indeterminate, whereas only a small number of cases show a documented viral infection. We present the first reported case of isolated acute hepatic failure in an infant in the setting of a human parechovirus (HPeV) infection. HPeV also may have been contributory to the posttransplant complication of 2 intussusceptions. This is a 10-month-old girl who presented with only symptoms of fussiness and was noted to have progressive decline in synthetic liver function as well as worsening coagulopathy requiring a liver transplant. The acute liver failure was in the setting of a positive serum RNA HPeV, subtype 3 (HPeV-3), after extensive diagnostic testing with genetic, autoimmune, and infectious causes otherwise negative. After liver transplantation, the postoperative course was complicated by both an ileal-ileal intussusception as well as a jejunal intussusception. Viral testing in pediatric acute liver failure is often performed, but the workup is frequently incomplete. This case report would support more extensive viral testing in this population of patients. In the setting of HPeV, clinicians could be alerted to the possibility of delayed gastrointestinal pathology in the posttransplant phase. Wider use of routine HPeV testing may more clearly define the variable clinical presentations and outcomes.
