ABSTRACT
ObjectiveWhile pediatric population has largely remained free of severe COVID-19, in some cases SARS-CoV-2 infection has been associated with complications like Multiple Inflammatory Syndrome in children (MIS-C). We mention another unique presentation subsequent to asymptomatic infection of SARS-CoV-2, a unique form of hepatitis designated by us as COVID-19 Associated Hepatitis in Children (CAH-C). The contrasting clinical presentations, temporal association and viral parameters of CAH-C cases, to the MIS-C cases are presented here. MethodsAs a retrospective and follow-up observational study we reviewed all children testing positive for SARS-CoV-2 during study period. Children presenting with "sudden onset of hepatitis, elevated transaminases, non-obstructive jaundice, lacking marked inflammatory responses and without evidence of (a) other known causes of acute hepatitis or previous underlying liver disease (b) multi-system involvement" were classified as CAH-C, are described here. ResultsAmong 475 children tested positive, 47 patients presented with hepatitis, 37 patients had features of CAH-C, having symptoms of hepatitis only, with un-elevated inflammatory markers and uneventful recovery following supportive treatment. Whereas remaining 10 MIS-C hepatitis had protracted illness, multiple system involvement, required admission to critical care, and had mortality of 30%. ConclusionWith the emergence of newer variants of concern (VOC) including the Delta variant which predominated the second wave of infections in India and has now spread to more than 142 countries with changing presentations, CAH-C might be one of them. Cases of such new entities need to be identified early and differentiated from other emerging syndromes in children during the ongoing pandemic for preventing adversities by timely intervention. Conflicts of interestThe authors declare that they have no conflicts of interest related to the study or its findings. All authors have contributed to the conceptualization and manuscript writing of the study, the final version is approved by all the authors. We declare there are no competing interests involved among the authors. Funding and ethics approvalCurrent research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The follow-up and analysis work was performed after obtaining due approval of human ethics committee of the institution (Ref no. IEC/BMC/80/21).
