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Human Parechovirus as a Cause of Isolated Pediatric Acute Liver Failure. Pediatrics 2016 11;138(5)

Date

12/13/2016

Pubmed ID

27940759

DOI

10.1542/peds.2016-0233

Scopus ID

2-s2.0-84994803466   4 Citations

Abstract

Among infants, almost half of acute liver failure cases are classified as indeterminate, whereas only a small number of cases show a documented viral infection. We present the first reported case of isolated acute hepatic failure in an infant in the setting of a human parechovirus (HPeV) infection. HPeV also may have been contributory to the posttransplant complication of 2 intussusceptions. This is a 10-month-old girl who presented with only symptoms of fussiness and was noted to have progressive decline in synthetic liver function as well as worsening coagulopathy requiring a liver transplant. The acute liver failure was in the setting of a positive serum RNA HPeV, subtype 3 (HPeV-3), after extensive diagnostic testing with genetic, autoimmune, and infectious causes otherwise negative. After liver transplantation, the postoperative course was complicated by both an ileal-ileal intussusception as well as a jejunal intussusception. Viral testing in pediatric acute liver failure is often performed, but the workup is frequently incomplete. This case report would support more extensive viral testing in this population of patients. In the setting of HPeV, clinicians could be alerted to the possibility of delayed gastrointestinal pathology in the posttransplant phase. Wider use of routine HPeV testing may more clearly define the variable clinical presentations and outcomes.

Author List

Bigelow AM, Scott JP, Hong JC, Cronin DC, Vitola BE, Fons RA, Petersen TL

Authors

Roger A. Fons MD Assistant Professor in the Anesthesiology department at Medical College of Wisconsin
Tara L. Petersen MD, MSED Associate Professor in the Pediatrics department at Medical College of Wisconsin
John P. Scott MD Associate Professor in the Anesthesiology department at Medical College of Wisconsin
Bernadette Vitola MD Associate Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Female
Humans
Ileal Diseases
Infant
Intussusception
Jejunal Diseases
Liver Failure, Acute
Liver Transplantation
Parechovirus
Picornaviridae Infections
Postoperative Complications
RNA, Viral
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a