Scarlet fever associated with hepatitis in pediatrics: a case report / Hepatitis asociada a escarlatina en pediatría: reporte de caso

INTRODUCCIÓN: La escarlatina es una enfermedad común en Pediatría, causada por Estreptococo beta hemolítico grupo A (SBHGA), la cual generalmente se presenta después de un episodio de faringitis, y con excelente pronóstico general. La hepatitis secundaria a escarlatina es una complicación, descrita muy rara vez en niños. Nuestro objetivo fue reportar la ocurrencia de hepatitis secundaria a escarlati na en un paciente pediátrico. CASO CLÍNICO: Varón de 12 años cursando escarlatina, quien se presentó con una historia de 4 días de ictericia, coluria y disminución del apetito. Los exámenes de laboratorio revelaron elevación de las transaminasas y de los niveles de bilirrubina total y directa, y estudios vira les negativos para Hepatitis A, B y C, Virus de Epstein Barr, Parvovirus B19, Citomegalovirus, Virus Herpes 6 y Herpes simplex 1 y 2. Ecografía abdominal fue normal. DISCUSIÓN: La hepatitis es una complicación inhabitual de la escarlatina, cuya patogénesis aún no está clara. La producción de citoquinas a través del daño celular mediado por la exotoxina pirógena estreptocócica, se ha propuesto como un posible mecanismo de hepatotoxicidad en infecciones por SBHGA. CONCLUSIÓN: La hepati tis asociada a escarlatina continúa siendo una entidad rara, pero de curso benigno, con recuperación plena en semanas a meses.

INTRODUCTION: Scarlet fever is a common illness in pediatrics caused by group A beta-hemolytic streptococcus (GABHS), which usually occurs after an episode of pharyngitis, and has an overall excellent prognosis. Hepatitis secondary to scarlet fever is a rare complication described in adults and even less frequently in children. Our objective was to describe a case of hepatitis secondary to scarlet fever in a pediatric patient. CLINICAL CASE: A 12-year-old male with scarlet fever presented with a 4-day history of jaundice, dark urine, and decreased appetite. Laboratory tests revealed elevated liver enzy mes and total and direct bilirubin levels, and negative studies for hepatitis A, B and C, Epstein Barr virus, parvovirus B19, adenovirus, cytomegalovirus, human herpes virus-6, and herpes simplex virus 1 and 2. Abdominal ultrasound examination was normal. DISCUSSION: The pathogenesis of scarlet fever associated hepatitis remains unclear. Streptococcal pyrogenic exotoxin mediated cellular injury via cytokine production has been proposed as a possible mechanism of hepatotoxicity in GABHS infections. CONCLUSION: Hepatitis secondary to scarlet fever remains a rare but benign entity, with complete recovery expected over weeks to months.

Hepatitis colestásica por Mycoplasma pneumoniae sin compromiso pulmonar: caso clínico y revisión de la literatura / Cholestatic hepatitis due to mycoplasma pneumoniae without lung involvement: case report and review

El compromiso hepático es una rara manifestación de la infección por Mycoplasma pneumoniae. Casos de hepatitis colestásica sin compromiso pulmonar han sido descritos en niños con infección por M. pneumoniae, pero en adultos sólo unos pocos casos han sido reportados. En este artículo, presentamos el caso de un hombre de 21 años que consultó por un cuadro de fiebre, ictericia y dolor epigástrico asociado con alteración de los exámenes de laboratorio hepático. Los estudios serológicos de M. penumoniae fueron positivos para IgM e IgG. Los síntomas y exámenes de laboratorio mejoraron completamente luego del tratamiento con claritromicina y ácido ursodeoxicólico.

Liver dysfunction is an unusual manifestation of Mycoplasma pneumoniae infection. Cases of cholestatic hepatitis without pulmonary involvement have been described in children with M. pneumoniae infection,but only a few cases have been reported in adults. In this article, we report the case of a 21-year-old man who presented fever, jaundice and epigastric pain associated with altered liver function tests. Serological tests for M. pneumoniae were positive for IgG and IgM. Clinical symptoms and laboratory tests resolved completely after treatment with clarithromycin and ursodeoxicolic acid. A review of reported cases of liver involvement in M. pneumoniae infection is presented.

Coxiella burnetii in Egyptian children with hepatitis

To estimate the incidence of Coxiella burnetii infection among Egyptian children with hepatitis Ain Shams University Children's Hospital and Imbaba Fever Hospital Included ninety children aged between 5-14 years [median: 10 years]. Male to female ratio was 2: 1. They were divided into two groups, group [I] comprised sixty children with hepatitis and group [2] included thirty healthy children [controls]. Both groups were age and sex matched. Both groups were subjected to history taking, thorough clinical examination and investigations which included complete hemogram and ESR levels, liver function tests and serologic tests for the detection of HAV IgM antibodies [ELISA], HBs Ag HBs-Ab [ELISA], HCV antibodies [INNO test] and Coxiella burnetii IgM antibodies [indirect fluorescence technique]. The present study showed that the incidence of Coxiella burnetii infection [Q fever] among patients with hepatitis was 11.7% and those of hepatitis A, B, C and other undiagnosed hepatitides were [48.3%], [20%], [6.7%] and [13.3%] respectively. High fever and CNS manifestations but not hepatomegaly and/or deep jaundice were the cardinal findings in all cases of Q fever hepatitis. Meanwhile, two out of seven [28.57%] cases had pneumonia but none had any cardiac abnormalities. Significant leukocytosis and high ESR levels were observed in patients with Q fever hepatitis. The liver enzymes were markedly elevated in all patients with hepatitis including Q fever with insignificant difference between different groups. Q fever hepatitis is not uncommon in children. The diagnosis should be considered in any child presenting with hepatitis specially when there is high fever, CNS symptoms, leukocytosis and elevated ESR levels

Fulminant hepatitis, possible virus origin: a report of seventeen cases in southern Thailand.

This report described seventeen patients suffering from fulminant hepatitis and had a rapid fatal course. They were all residents of Southern Thailand. Fourteen cases were recognized between April and August which is the beginning of the rainy season in this part of the country. All age groups were found with males slightly predominant. Clinical manifestation presented with fever and later developed jaundice, convulsion and other central nervous system symptoms, liver failure and acute renal failure. Four cases had pneumonia and another three cases had pleural effusion. Laboratory investigations revealed hyperbilirubinemia, marked increase in serum transaminases, a variable alkaline phosphatase level and electrolytes derangement. HBsAg was positive in only two of fourteen cases. Blood cultures and serological examination for infections were unfruitful. Histopathological changes of the liver were classified into three types; type 1 massive hepatocellular coagulation necrosis; type 2 massive scattered hepatocellular necrosis and type 3 massive bridging hepatocellular necrosis. Electron microscopy of five cases revealed spherical viral-like particles ranging in size 70 to 90 nm in diameter, in the cytoplasm of liver cells. This is believed to be a unique type of fulminant hepatitis, possibly viral in origin, and were clinically and pathologically different from the previously described fulminant viral hepatitis.