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Acute liver failure with a massive upper GI bleed meeting the criteria of MIS-C
Anshika Mishra1, Jaya Gupta2, Areesha Alam2
1Pediatrics, King George's Medical University, Lucknow, India anshikamishra63796@gmail.com.
Insights
Multisystem inflammatory syndrome in children (MIS-C) can cause severe liver issues and gastrointestinal bleeding. Early diagnosis and treatment with steroids and immunoglobulins are crucial for recovery.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Critical Care Medicine
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious complication of COVID-19.
- Limited data exists on the gastrointestinal manifestations of MIS-C, particularly liver involvement.
Observation:
- A previously healthy toddler presented with acute liver failure, duodenal lesions, severe hematemesis, and hemorrhagic shock.
- Initial investigations ruled out common infectious hepatitis and acute COVID-19 infection, but SARS-CoV-2 antibody testing was reactive.
Findings:
- The patient exhibited persistent transaminitis, coagulopathy, and elevated inflammatory markers.
- Endoscopic findings revealed a Forrest grade III duodenal ulcer, leading to a diagnosis of MIS-C-associated hepatitis.
Implications:
- This case highlights MIS-C as a potential cause of acute liver failure and upper gastrointestinal bleeding in children.
- Prompt recognition and treatment with corticosteroids and IVIG can lead to favorable outcomes in severe MIS-C cases.
Abstract:
Multisystem inflammatory syndrome in children (MIS-C) is a known complication of COVID-19. There is still limited knowledge about this condition. Here, we report the case of a previously healthy toddler boy, who presented with acute liver failure and duodenal lesions resulting in severe haematemesis and haemorrhagic shock, requiring intensive care unit care. The patient had persistent transaminitis, a deranged coagulation profile, inflammatory markers were elevated, and laboratory tests were negative for common infectious hepatitis aetiologies as well as COVID-19 Reverse transcription polymerase chain reaction. His COVID-19 antibody was reactive. Upper gastrointestinal endoscopy revealed a Forrest grade III duodenal ulcer. Looking into the constellation of symptoms and laboratory findings a confirmed diagnosis of acute viral hepatitis caused by MIS-C was made. Hence, he was given intravenous methylprednisolone along with intravenous immunoglobulins, after which he improved clinically and transaminitis resolved. The patient was discharged on clinical improvement and was doing fine on follow-up up to 6 months.
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