Suspected fibrosing cholestatic hepatitis in an immunocompetent child with hepatitis C: Case report

A 12-year-old boy presented to our center with elevated aminotransferases, jaundice, right upper quadrant tenderness, and hepatomegaly. Evaluation revealed a highly elevated blood hepatitis C virus (HCV) ribonucleic acid (RNA) level, and liver biopsy showed canalicular and intrahepatic cholestasis, feathery degeneration of hepatocytes, and periportal/perisinusoidal fibrosis. Though there were atypical biopsy features, including absence of bile ductular reaction, we diagnosed suspected fibrosing cholestatic hepatitis (FCH). FCH secondary to HCV infection has been reported exclusively in immunosuppressed adults. To our knowledge, this is the first reported case of suspected FCH in a child, and the first reported case of suspected HCV-related FCH in any immunocompetent patient. Our patient was successfully treated with sofosbuvir/velpatasvir with sustained virologic response at 12 weeks. We conclude that FCH should be considered on the differential whenever any child with HCV infection presents with evidence of worsening liver injury including new hepatomegaly or jaundice.