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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.

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Background: Brain Abscess (BA) is an uncommon intracranial suppurative infectious disease, especially in children. Its treatment involves surgery and prolonged antibiotics courses. Objectives: The current study aimed at describing the clinical characteristics of children with BA, treated at the central Tunisian region health center. Methods: A retrospective study, lasting 19 years (1995 to 2014), was conducted in four Tunisia pediatric departments of the central region. Forty-one children having radiological abnormalities suggestive of BA and confirmed operative lesions were included. Mycobacterial, parasitic or fungal abscesses were excluded. Medical records were analyzed for age, gender, presenting symptoms, predisposing factors, imaging, microbiology findings, treatment, and outcome. Results: The mean age was 4.9 years (range: 4 days to 16 years). The most common clinical presentations were increased intracranial pressure symptoms (87%). Brain Abscess was diagnosed in 95.1% on the basis of cranial imaging. The majority of abscesses were supratentorial (92.6%). The most frequent etiology was contiguous infections of the skull (63.4%). No predisposing factor was found in 17%. Intravenous antibiotics were given in all cases with surgical drainage in 63.4%, causative organisms were identified in 53.7%; gram positive cocci in 21.9%, and gram negative cocci in 9.7%. The mortality rate was 24.3%. Age of less than two years was the only statistically significant identified prognostic factor. Conclusions: The current study confirmed the severity of this pathology and underlined the importance of early diagnosis and management.