Perinatal cytomegalovirus hepatitis in Saudi infants: a case series

Cytomegalovirus [CMV] is the most common congenital viral infection, occurring in 0.4%-2.3% of all live births. The clinical manifestations of CMV are multiorgan involvement. Currently, the numbers of studies of hepatic CMV infection in immunocompetent infants are insufficient and little information exists in the medical literature about the hepatic manifestations and complications of CMV. Nine infants diagnosed with hepatic CMV infection were included in the study. The diagnosis was based on the presence of IgM anti-CMV antibodies titer in serum and detection of CMV-DNA in blood. The authors identified clinical characteristics, biochemical characteristics, immunologic markers, and the outcome of hepatic CMV with or without treatment. Jaundice was the most common clinical feature of CMV infection in infancy [100%]. Hepatic abnormalities in the form of cholestasis [defined as a serum conjugated bilirubin concentration greater than 17.1 micro mol/L or greater than 20% of the total serum bilirubin] were found in all patients [100%], hepatitis [77%], hypoalbuminemia [55%], elevated alkaline phosphatase, and gamma- glutamyltransferase [77%]. Other findings showed hepatosplenomegaly [44%], thrombocytopenia [22%] and low birth weight [11%]. The treatment of hepatic CMV infection was indicated in 66% and was not indicated in 33%. Both of them had resolved cholestasis and hepatitis. Jaundice and cholestasis were the most common clinical features of hepatic CMV infections. Hepatic CMV infection in young infants is often a self-limited illness that does not require antiviral therapy. Most of the patients with hepatic CMV infection had favorable outcome

Seroconversion of hepatitis B envelope antigne [HBeAg] by entecavir in a child with chronic hepatitis B

Hepatitis B virus [HBV] infection is a worldwide health problem. Consensus guidelines for the treatment of chronic HBV in children have not been established, and indications for antiviral therapy in adults with chronic HBV infection may not be applicable to children. The medications that are Food and Drug Administration approved for the treatment of children with HBV include interferon [IFN]-alpha and lamivudine. Nondetectable serum HBV deoxyribonucleic acid, Hepatitis B envelope antigen [HBeAg] loss, and HBeAg seroconversion following 1 year duration of entecavir treatment. A review of the literature of entecavir treatment of chronic hepatitis B in children is also provided

Eosinophilic esophagitis in Saudi children: symptoms, histology and endoscopy results

Eosinophilic esophagitis [EE] is a clinicopathologic entity characterized by esophageal symptoms in association with a dense eosinophilic infiltrate currently defined as >15 eosinophils per high power field in the appropriate clinical context. This is the first pediatric study in Saudi Arabia to give the experience with EE and examine its symptom, histology and endoscopy results. Retrospective chart review of all patients diagnosed with EE at National Guard Hospital, Jeddah Between 2007 and 2009. The authors identified EE on histologic criteria [>15 eosinophils per high-power field] together with their clinical context. The authors reviewed medical records for details of clinical presentation, laboratory data, radiologic, endoscopic, and histologic findings, and the results of treatment. We identified 15 patients in our database in the last three years. 100% of the patients were males. The median age at presentation was 10 years [range, 3-17 years]. The commonly reported symptoms were failure to thrive [86%], epigastric abdominal pain [53%], poor eating [40%], dysphagia with solid food [26%], food impaction [13%], and vomiting [20%]. Asthma was reported in 46% and allergic rhinitis in 40%. Peripheral eosinophilia [>0.7 x 10/1] was found in 66%. High serum IgE Level [>60 lU/ml] was found in 60%. Upper endoscopic analysis revealed esophageal trachealization in 46%, esophageal erythema in 46%, white specks on the esophageal mucosa in 33%, esophageal narrowing in 13%, and normal endoscopy in 13%. The mean eosinophils per high-power field was 30.4 [range, 20-71]. Histologic characteristics included degranulated eosinophils [86%], basal cell hyperplasia [93%] and eosinophils clusters [micro-abscess] in 73%. The treatment of EE revealed that they used swallowed corticosteroid in 50%, proton pump inhibitors in 66%, elemental diet/ food elimination in 13% and systemic corticosteroid in 13%. Failure to thrive and abdominal pain in a male, atopic school-aged child was the most common feature of EE. Peripheral eosinophilia, high serum IgE and endoscopic esophageal erythema and trachealization should significantly raise the clinical index of suspicion for the diagnosis of EE