Case Report
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World J Hepatol. Apr 27, 2013; 5(4): 226-229
Published online Apr 27, 2013. doi: 10.4254/wjh.v5.i4.226
Giant cell hepatitis with autoimmune hemolytic anemia in a nine month old infant
Jihene Bouguila, Sameh Mabrouk, Samia Tilouche, Dajla Bakir, Amel Trabelsi, Amel Hmila, Lamia Boughammoura
Jihene Bouguila, Samia Tilouche, Amel Hmila, Lamia Boughammoura, Department of Paediatrics, Hospital Farhat Hached, 4000 Sousse, Tunisia
Sameh Mabrouk, Department of Paediatrics, Hospital Sahloul, 4011 Sousse, Tunisia
Dajla Bakir, Department of Radiology, Hospital Farhat Hached, 4000 Sousse, Tunisia
Amel Trabelsi, Laboratory of Anatomopathology, Hospital Farhat Hached, 4000 Sousse, Tunisia
Author contributions: Bouguila J contributed to this work; Mabrouk S, Tilouche S, Hmila A and Boughammoura L designed the research; Bakir D performed radiological assessment; Trabelsi A analyzed the histological exams.
Correspondence to: Dr. Bouguila Jihene, Department of Paediatrics, Hospital Farhat Hached, City of Ibn El Jazzar, 4000 Sousse, Tunisia. jbouguila@yahoo.fr
Telephone: +216-98-407764 Fax: +216-73-226702
Received: August 8, 2012
Revised: September 25, 2012
Accepted: November 17, 2012
Published online: April 27, 2013
Processing time: 262 Days and 6.1 Hours
Abstract

Giant cell hepatitis (GCH) with autoimmune hemolytic anemia is a rare entity, limited to young children, with an unknown pathogenesis. We report the case of 9-mo old who presented with fever, diarrhea and jaundice four days before hospitalization. Physical examination found pallor, jaundice and hepatosplenomegaly. The laboratory workup showed serum total bilirubin at 101 μmol/L, conjugated bilirubin at 84 μmol/L, hemolytic anemia, thrombocytopenia and immunoglobulin G (IgG) and anti-C3d positive direct Coombs’ test. The antinuclear, anti-smooth muscle and liver kidney microsomes 1 non-organ specific autoantibodies, antiendomisium antibodies were negative. Serological assays for viral hepatitis B and C, cytomegalovirus, herpes simplex and Epstein Barr virus were negative. The association of acute liver failure, Evan’s syndrome, positive direct Coomb’s test of mixed type (IgG and C3) and the absence of organ and non-organ specific autoantibodies suggested the diagnosis of GCH. The diagnosis was confirmed by a needle liver biopsy. The patient was treated by corticosteroids, immunomodulatory therapy and azathioprine but died with septicemia.

Keywords: Giant cell hepatitis; Anemia; Hemolytic; Autoimmune; Child