Hepatitis A, a potential life-threatening condition in small children with Wilson disease – a case report

Abstract

Introduction. Hepatitis A is the most common cause of acute hepatitis in children. Wilson disease (WD) is a rare autosomal recessive condition that can result in chronic liver disease. Hepatitis A may be a trigger in the onset of WD. Case presentation. We report the case of a previously healthy 7-year-old girl, admitted in our clinic for upper digestive hemorrhage, jaundice and increased abdomen in volume. The onset of the disease was 1 month before when she was diagnosed with hepatitis A. The laboratory tests at the time of admission pointed out anemia, increased inflammatory biomarkers, conjugated hyperbilirubinemia, hypoalbuminemia, hepatic cytolysis, elevated alkaline phosphatase levels, hyponatremia, and severe coagulopathy. The abdominal ultrasound showed hepatomegaly, inhomogeneous structure, granular echogenicity, with micronodules, diameter of the portal vein 9 mm, altered portal vein pulsatility, splenomegaly and ascites. The upper digestive endoscopy revealed hyperemia and edema of the gastric mucosa, adherent gastric clots, incipient varices of the gastric fornix. The echocardiography showed mild pleural and pericardial effusion. We ruled out hepatitis B, hepatitis C, toxoplasma, rubella, herpes virus, Epstein Barr virus, cytomegalovirus, but also autoimmune hepatitis. Based on the low levels of ceruloplasmin and serum copper, and the positive D-penicilamine test associated to gastric varices and portal hypertension, we established the diagnosis of WD. The ophthalmology and neurological consults found no pathological changes. The patient’s clinical and biochemical evolution was favorable after the initiation of chelation therapy. Conclusion. Though rare, the association between hepatitis A and WD can result in acute liver failure and death, especially in previously healthy children.

Keywords

• hepatitis a
• wilson disease
• hepatic cirrhosis
• child
• acute liver failure