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Scarlet fever associated with hepatitis in pediatrics. A case report
Arvind V Panchoo1, Miguel Saps2, Edgardo D Rivera Rivera2
1Department of Pediatrics, Jackson Memorial Hospital, USA.
Insights
Scarlet fever can rarely cause hepatitis in children, presenting with jaundice and elevated liver enzymes. This complication is typically benign, with full recovery expected within weeks to months.
Area of Science:
- Pediatric Infectious Diseases
- Hepatology
- Microbiology
Background:
- Scarlet fever, caused by group A beta-hemolytic Streptococcus (GABHS), is a common pediatric illness.
- Hepatitis is a rare complication of scarlet fever, observed more frequently in adults than children.
- This case report details a pediatric patient experiencing hepatitis secondary to scarlet fever.
Observation:
- A 12-year-old male presented with jaundice, dark urine, and anorexia following a scarlet fever diagnosis.
- Laboratory results showed elevated liver enzymes and bilirubin levels.
- Extensive testing excluded common viral hepatitis and other infectious causes of hepatitis.
Findings:
- The patient's presentation and laboratory findings were consistent with hepatitis.
- No other identifiable cause for hepatitis was found, suggesting a link to scarlet fever.
- Abdominal ultrasound revealed no abnormalities.
Implications:
- This case highlights hepatitis as a rare, yet possible, complication of scarlet fever in pediatric patients.
- The exact pathogenesis remains unclear, but streptococcal pyrogenic exotoxins are implicated.
- Complete recovery is anticipated, underscoring the generally benign nature of this complication.
Introduction:
Scarlet fever is a common illness in pediatrics caused by group A beta-hemolytic strep tococcus (GABHS), which usually occurs after an episode of pharyngitis, and has an overall excellent prognosis. Hepatitis secondary to scarlet fever is a rare complication described in adults and even less frequently in children. Our objective was to describe a case of hepatitis secondary to scarlet fever in a pediatric patient.
Clinical Case:
A 12-year-old male with scarlet fever presented with a 4-day history of jaundice, dark urine, and decreased appetite. Laboratory tests revealed elevated liver enzy mes and total and direct bilirubin levels, and negative studies for hepatitis A, B and C, Epstein Barr virus, parvovirus B19, adenovirus, cytomegalovirus, human herpes virus-6, and herpes simplex virus 1 and 2. Abdominal ultrasound examination was normal.
Discussion:
The pathogenesis of scarlet fever associated hepatitis remains unclear. Streptococcal pyrogenic exotoxin mediated cellular injury via cytokine production has been proposed as a possible mechanism of hepatotoxicity in GABHS infections.
Conclusion:
Hepatitis secondary to scarlet fever remains a rare but benign entity, with complete recovery expected over weeks to months.
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