Pediatric Acute Liver Failure: A Clinicopathological Perspective

Putra, Juan; Ng, Vicky L.; Perez‐Atayde, Antonio R.

doi:10.1177/10935266211067893

Cited by 5 publications

(2 citation statements)

References 90 publications

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“…The lesser degree in the severity of portal inflammation in the control group was expected and in keeping with the postulation that at least some of the indeterminate pediatric severe acute hepatitis/acute liver failure cases may be caused by occult acetaminophen toxicity, unrecognized viral infection, or undiagnosed metabolic disorders that are characterized by confluent necrosis and milder portal inflammation. 14 Taken together, these observations suggest that in young children with unexplained acute hepatitis (common causes for hepatitis including autoimmune hepatitis have been ruled out), the finding of a moderateto-severe autoimmune hepatitis-like pattern in a biopsy specimen is a relatively strong indicator for an association with adenovirus infection, providing additional clues for future investigations in pediatric acute hepatitis of indeterminate etiology.…”

Section: Discussionmentioning

confidence: 80%

Clinicopathologic Features of Severe Acute Hepatitis Associated With Adenovirus Infection in Children

Liang

Kelly²,

Pai

et al. 2023

American Journal of Surgical Pathology

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A recent increase in reports of severe acute hepatitis of unknown etiology in children is under investigation. Although adenovirus has been frequently detected, its role remains unclear, and systematic histopathologic analysis is lacking. We conducted a retrospective study of 11 children hospitalized between October 2021 and May 2022 with unexplained acute hepatitis and concurrent adenovirus infection. Liver biopsies collected shortly after admission demonstrated moderately to severely active hepatitis in 8/11 (73%) cases, characterized by marked portal mixed inflammation, moderate-to-severe interface activity, and milder lobular inflammation. Clusters of plasma cells were present in 6/11 (55%) cases, mimicking autoimmune hepatitis. Semiquantitative scoring of 17 discrete histologic features found that greater degrees of portal inflammation, interface activity, bile duct injury, bile ductular reaction, lobular inflammation, Kupffer cell activation, and hepatocyte focal necrosis were significantly more common in these cases in comparison to the control group of unexplained acute severe hepatitis without adenovirus infection. Liver biopsy immunohistochemistry was negative for adenovirus in all cases. Polymerase chain reaction testing of liver tissue was positive for the enteric adenovirus serotypes 41 (species F) in 10/11 (91%) cases. An immunoprofile study of hepatic infiltrating lymphocytes in 1 patient revealed the presence of large numbers of CD3+ and CD4+ lymphocytes. Nine patients received supportive treatment without steroids and recovered without the need for liver transplantation. In summary, liver injury in children with severe acute hepatitis and adenovirus infection is characterized by a hepatitic pattern that resembles severe autoimmune hepatitis and may represent an immune-mediated process associated with viral infection.

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Section: Discussionmentioning

confidence: 80%

Clinicopathologic Features of Severe Acute Hepatitis Associated With Adenovirus Infection in Children

Liang

Kelly²,

Pai

et al. 2023

American Journal of Surgical Pathology

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“…The three stages of symptoms are prodromal, icteric, and convalescent. The symptoms differ depending on the clinical/infection phase of the patient [ 37 ]. When the virus enters the bloodstream, it starts releasing compounds throughout the prodromal stage.…”

Section: Hepatitismentioning

confidence: 99%

Suspected Adenovirus Causing an Emerging HEPATITIS among Children below 10 Years: A Review

et al. 2022

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In October 2021, a case of acute hepatic failure without any known cause was identified in the United States of America. Upon further investigation, other children aged 1–6 years were reported to have the same liver failure, and some of them were positive for adenovirus 41 type F. On 21 April 2022, the Centers for Disease Control and Prevention (CDC) released an alert after 74 cases were identified in United Kingdom (UK) between 5 and 8 April in children below 10 years of age, some of whom were also found to be positive for SARS-CoV-2. All the patients showed symptoms such as vomiting, diarrhea, jaundice, and abdominal pain. The patients’ liver enzymes were remarkably increased. A total of 650 cases had been reported from 33 countries as of 27 May 2022, among which 222 cases were reported in the UK alone. No connection with SARS-CoV-2 or its vaccine has been found so far. However, the suspected cause is adenovirus, including its genomic variations, because its pathogenesis and laboratory investigations have been positively linked. Until further evidence emerges, hygiene precautions could be helpful to prevent its spread.

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Pediatric liver transplant for acute liver failure: Defining the standard nutrition and clinical evolution: An observational study

Zamberlan,

Bonfim,

Tannuri

et al. 2024

Nut in Clin Prac

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BackgroundPediatric acute liver failure (PALF) is a clinical diagnosis in which previously asymptomatic children exhibit a rapid loss of liver function.ObjectivesTo describe the clinical and nutrition conditions at admission and during hospitalization in patients with PALF who underwent liver transplantation (LT) at a referral center and establish a possible association between nutrition status and prognosis in this population.MethodsA prospective study was conducted on children underwent LT because of PALF. Nutrition assessment was performed at admission and repeated weekly until hospital discharge, and their relationships with clinical outcomes were tested.ResultsThe study population consisted of 23 patients with a median age of 60 months and, in most cases, the etiology of acute liver failure (ALF) was indeterminate (69.6%). The majority of the patients were well nourished according to the z score body mass index‐for‐age (82.6%) and z arm circumference‐for‐age (zAC/A) (82.6%). A decline in nutrition status was observed in 47.6% of the patients, as indicated by a decrease in zAC. Clinical and nutrition improvement was demonstrated by the progressive increase in zAC, serum albumin levels, and phase angle (PA) values and by the reduction in C‐reactive protein levels. There was no statistically significant relationship between nutrition status and clinical outcomes.ConclusionMost children and adolescents with ALF presented adequate nutrition status at the time of LT, and some patients worsened their nutrition status during hospitalization, suggesting that post‐LT is a period of high nutrition risk, and early nutrition therapy (NT) must be a priority in these patients.

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Pediatric Acute Liver Failure: A Clinicopathological Perspective

Cited by 5 publications

References 90 publications

Clinicopathologic Features of Severe Acute Hepatitis Associated With Adenovirus Infection in Children

Clinicopathologic Features of Severe Acute Hepatitis Associated With Adenovirus Infection in Children

Suspected Adenovirus Causing an Emerging HEPATITIS among Children below 10 Years: A Review

Pediatric liver transplant for acute liver failure: Defining the standard nutrition and clinical evolution: An observational study

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