Pediatric acute viral hepatitis with atypical variants: Clinical dilemmas and natural history

Area of Science:

• Pediatric Gastroenterology
• Hepatology
• Viral Hepatitis Research

Background:

• Classical acute viral hepatitis (AVH) typically resolves without complications.
• Atypical AVH manifestations present significant morbidity and diagnostic challenges in children.
• These atypical forms can mimic chronic liver disease (CLD) or acute-on-chronic liver failure.

Purpose of the Study:

• To delineate atypical presentations of acute viral hepatitis in children.
• To highlight the diagnostic difficulties in differentiating these forms from chronic liver disease.
• To emphasize the importance of recognizing deviations from typical AVH for accurate diagnosis and management.

Main Methods:

• Review of clinical presentations of children with AVH.
• Analysis of atypical manifestations including prolonged cholestasis, relapsing hepatitis, ascitic form, late-onset hepatic failure (LOHF), and hemolysis.
• Comparison with features of chronic liver disease (CLD) and acute-on-chronic liver failure.

Main Results:

• Atypical AVH includes prolonged cholestasis, relapsing hepatitis, ascitic form, LOHF, and hemolysis.
• These entities cause significant liver dysfunction and overlap with CLD and acute-on-chronic liver failure.
• Intravascular hemolysis is often linked to glucose-6-phosphate dehydrogenase deficiency but can also occur in Wilson disease or autoimmune hepatitis.

Conclusions:

• Identifying atypical AVH manifestations is critical for accurate diagnosis in children.
• Distinguishing these forms from CLD requires careful evaluation and often long-term follow-up.
• Recognizing deviations from typical AVH aids in targeted therapy and reduces unnecessary investigations.