Journal of Tropical Pediatrics Advance Access originally published online on February 8, 2009
Journal of Tropical Pediatrics 2009 55(5):335-337; doi:10.1093/tropej/fmp004
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Case Reports |
Parvovirus B19-induced Thrombocytopenia and Anemia in a Child with Fatal Fulminant Hepatic Failure Coinfected with Hepatitis A and E Viruses
Division of Virology, Department of Microbiology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, UP, India
Correspondence: Dr Janak Kishore, Professor, Division of Virology, Department of Microbiology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow 226014, UP, India. Tel.: +91 522 2668700/2668800; Fax: +91 522 2668017/2668100; E-mail: <janaksgpgi{at}yahoo.co.in>.
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Abstract |
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A 5-year-old male, drowsy, jaundiced child presented with fulminant hepatitis and had HAV and HEV infection. He had hepatic encephalopathy grade 1, fever, pallor, hypotension, crepitations in his right lung base and hepatosplenomegaly with dyspnoea. He had highly raised liver enzymes and hypoalbuminemia (2.8 g/dl) but anemia (hemoglobin of 7.7 g/dl and 5.7 g/dl 2 days later), reticulocytopenia and severe thrombocytopenia (44 x 109/l) were unexplained. Parvovirus B19-specific IgM antibodies and B19 DNA were found in the serum of the child. Chest X-ray showed pleural effusion and bronchopneumonia, while blood culture isolated coagulase-negative staphylococci (BACTEC 9120) and he had low oxygen saturation. Hence, he was treated with IV amoxicillin+ clavulinic acid and oxygen inhalation. He had seizures and cardiac arrest but was revived. On the third day his condition worsened and the child died despite intensive care. Hence it is concluded that his anemia and thrombocytopenia were B19 induced and this might have aggravated or caused fulminant hepatitis.
Key Words: hepatitis • liver failure • PCR • parvovirus B19