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A Case of Reactivated Acute Hepatitis in a 12-month-old Infant With Multiviral Infection, Including SARS-CoV-2 and
Jimmy Dawood1, Emily L Wickersham2,3,4, Claire P Witmer5,6
1From the School of Medicine, Uniformed Services University, MD.
Insights
This case study highlights severe adenovirus hepatitis in a previously healthy infant following SARS-CoV-2 infection. Reactivated hepatitis occurred with subsequent viral infections, emphasizing the need for careful monitoring.
Area of Science:
- Pediatric Hepatology
- Viral Hepatitis
- Immunology
Background:
- Adenovirus hepatitis is a growing global health concern with complex pathogenesis.
- While known to affect immunocompromised individuals, its course in healthy children is less understood.
- The interplay between SARS-CoV-2 and subsequent viral infections in pediatric hepatitis is an emerging area of study.
Observation:
- A previously healthy 12-month-old infant developed severe acute hepatitis after SARS-CoV-2 infection and a subsequent adenovirus infection.
- The infant presented with hepatitis and mild coagulopathy, improving with supportive care.
- Hepatitis reactivated during a third distinct viral infection, necessitating re-hospitalization and liver biopsy.
Findings:
- The case illustrates a prolonged and reactivated course of adenovirus hepatitis in a healthy child.
- Liver biopsy was performed to rule out underlying immunologic or metabolic conditions.
- The patient's history included sequential viral infections, suggesting a potential role in disease severity and reactivation.
Implications:
- This case offers valuable insights into the clinical management of severe adenovirus hepatitis in previously healthy children.
- It underscores the importance of considering sequential viral infections in the pathogenesis of pediatric hepatitis.
- Further research is needed to elucidate the mechanisms driving hepatitis reactivation and long-term outcomes in this population.
Abstract:
Adenovirus hepatitis is of global concern due to its increasing incidence and poorly understood pathogenesis. Historically, adenovirus has contributed to the development of severe hepatitis in immunocompromised patients. The clinical course and management of such infections in previously healthy children remains elusive. We present a case of severe acute hepatitis in a previously healthy 12-month-old infant with a history of SARS-CoV-2 infection followed by multiviral infection including adenovirus. Additional evaluation revealed acute hepatitis without evidence of acute liver failure except for mild coagulopathy. She demonstrated clinical improvement with supportive therapy but later experienced reactivated hepatitis in the setting of a third new viral infection thereby warranting a second hospitalization. A liver biopsy was obtained due to concern for an underlying immunologic or metabolic etiology of her prolonged hepatitis. Our case provides insight into the medical management and clinical course of a previously healthy child with a history of SARS-CoV-2 and adenovirus infections leading to reactivated acute hepatitis.
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