Sarma MS, Ravindranath A. Pediatric acute viral hepatitis with atypical variants: Clinical dilemmas and natural history. World J Hepatol 2022; 14(5): 944-955 [PMID: 35721282 DOI: 10.4254/wjh.v14.i5.944]
Corresponding Author of This Article
Moinak Sen Sarma, MD, Associate Professor, Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, Uttar Pradesh, India. moinaksen@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. May 27, 2022; 14(5): 944-955 Published online May 27, 2022. doi: 10.4254/wjh.v14.i5.944
Pediatric acute viral hepatitis with atypical variants: Clinical dilemmas and natural history
Moinak Sen Sarma, Aathira Ravindranath
Moinak Sen Sarma, Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
Aathira Ravindranath, Division of Pediatric Gastroenterology, Apollo BGS Hospitals, Mysuru 570023, Karnataka, India
Author contributions: Sarma MS contributed the supervision and critical review of final draft of the manuscript; Ravindranath A contributed the literature search, data collection and writing first draft of manuscript; both authors wrote, read and approved the final manuscript.
Conflict-of-interest statement: Both authors have no conflicts of interests to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Moinak Sen Sarma, MD, Associate Professor, Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, Uttar Pradesh, India. moinaksen@gmail.com
Received: January 6, 2022 Peer-review started: January 6, 2022 First decision: February 8, 2022 Revised: February 20, 2022 Accepted: May 5, 2022 Article in press: May 5, 2022 Published online: May 27, 2022 Processing time: 137 Days and 19.1 Hours
Abstract
Classical acute viral hepatitis (AVH) has an uncomplicated outcome. Acute liver failure has a grave prognosis. Atypical manifestations of AVH are a group of disorders that causes significant morbidity and dilemmas in children. These include prolonged cholestasis, relapsing hepatitis, ascitic form of AVH, late-onset hepatic failure (LOHF), intravascular hemolysis, and provoking an autoimmune trigger leading to autoimmune hepatitis. These entities cause significant liver dysfunction or worsening and are often difficult to differentiate from chronic liver disease (CLD). Ascitic form of AVH, LOHF, decompensated CLD and acute-on-chronic liver failure have significant overlapping features that need to be carefully dissected out. In many cases, only on long-term follow-up, these clinical entities can be separately identified. Intravascular hemolysis is usually caused by associated glucose-6-phosphate dehydrogenase deficiency. Rarely CLD such as Wilson disease and autoimmune hepatitis can also present with hemolysis in the initial presentation, which can mimic AVH with hemolysis. Identifying deviations from typical manifestations aid in avoiding unnecessary investigations, allowing focused therapy and alleviating anxiety.
Core tip: Acute viral hepatitis (AVH) in children can manifest with atypical features in about a quarter of children. The most common entities, such as prolonged cholestasis and relapsing hepatitis, cause liver dysfunction and are often confused with chronic liver diseases (CLDs). Similarly, ascitic form of AVH and late-onset hepatic failure are close differential diagnoses of acute-on-chronic liver failure and decompensated CLD. A combination of a thorough history, clinical findings, basic investigations and outcome on follow-up allows focused workup and management in atypical AVH.
