Lim CB1, Teh KH2, Sinniah M3, Kew ST4, Merican I4, Mohd Sham Kasim1
1. Paediatric Institute, Hospital Kuala Lumpur, Malaysia
2. Paediatric Department, Hospital Alor Setar, Kedah, Malaysia
3. Virology Division, Institute for Medical Research, Kuala Lumpur, Malaysia
4. Gastroenterology Hepatology Dept., Hospital Kuala Lumpur, Malaysia
CITATION: Lim CB, Teh Teh KH, Sinniah M, Kew ST, Merican I, Mohd Sham Kasim. Hepatitis C infection in a paediatric patient probably due to congenital infection. International Medical Research Journal. 1998 Jun;2(1):35–7.
ABSTRACT
Hepatitis C Virus (HCV) occurs particularly in multitransfused children. Perinatal vertical HCV transmission rarely occurs (7% ). We report a 9 month old Chinese girl presenting with severe unconjugated hyperbilirubinaemia since day 3 of life. She had septicaemia and received total parenteral nutrition(TPN) and fresh frozen plasma transfusion once (Donor Hepatitis B surface antigen (HbsAg) and Hepatitis C negative). She was referred for conjugated hyperbilirubinaernia at age 3 months with elevated alkaline phosphatase and liver enzymes. On examination. she was thriving, jaundiced with hepatosplenomegaly, stools and urine were yellow. Her mother had a history of tattooing and plastic surgery 10 years ago. There is no family history of autoimmune disease, liver disease, jaundice or blood transfusion. Blood film showed target cells, haemoglobin analysis was normal. Blood glucose, serum protein. albumin, prothrombin time and alpha-fetoprotein normal, raised aspartate transaminase (AST) 351 U/l alanine transaminase (ALT) 288 U/l and alkaline phosphatase (ALP) 515 U/l. Serum bilirubin was raised (total 156, conjugated 107, unconjugated 49 μmol/l). Ultrasound abdomen showed normal liver and spleen echotexture. Liver biopsy showed features of neonatal hepatitis. Other investigations including thyroid function tests. red blood cell galactose-1-phosphate uridyl transferase, serum alpha-1-antitrypsin, ceruloplasmin, iron, congenital infection screen, urine culture and Hepatitis A IgM were negative. Screening for HbsAg and human immunodeficiency virus were negative for the patient and family. At age 3 months. anti-HCV were positive in both patient and mother. Serum HCV-RNA by PCR technique was detected in the mother but was false negative in the patient. The clinical impression then was maternal HCV infection with maternal transplacentral anti-HCV IgG transfer to the patient, the hepatosplenomegaly being related to neonatal septicaemia/ TPN. At 6 months, jaundice had resolved but hepatosplenomegaly was still present. Serum ALP decreased to 340 U/l and ALT to 49 U/l. She had persistence of anti- HCV and developed HCV-RNA positivity. Hence. she has HCV viraemia and chronic HCV infection, probably congenitally (vertically) transmitted from maternal infection; HCV-RNA being falsely negative at age 3 months.
KEYWORDS: Hepatitis C, congenital, paediatric
