The association of viral hepatitis and acute pancreatitis is well described in the literature. Most of the cases occur in conjunction with fulminant hepatitis A and hepatitis B virus infections. The recent literature reports increasing number of cases of this complication secondary to hepatitis E virus (HEV) infection, mostly in young adults in regions endemic for the virus. Till date, to the authors' knowledge, there are 14 well-documented cases of HEV-associated acute pancreatitis in the literature. This study reports on a 7-year-old boy from India deficient in glucose 6 phosphate dehydrogenase (G6PD) with moderately severe pancreatitis, manifesting during the course of nonfulminant acute HEV infection. He developed extremely high serum bilirubin levels, probably attributed to the concomitant viral infection and his G6PD status. He recovered completely with conservative therapy. The present child is the youngest ever reported case till date with this complication secondary to HEV infection.
Thrombocytopenia of varying magnitude, usually without hemorrhagic manifestations, is commonly observed in Plasmodium falciparum and Plasmodium vivax malaria. However, severe thrombocytopenia associated with bleeding manifestations in malarial infection is distinctly unusual. The pathogenesis of this condition remains speculative till date, although several hypotheses have been put forward. We report a case of 4-year-old boy with P. vivax malaria, who developed severe thrombocytopenia during the course of his infection manifested by bleeding from skin and mucosal surfaces. He improved with antimalarial and intravenous immunoglobulin therapy. Clinicians caring for children should be aware of potential bleeding manifestations that may be the result of apparently innocuous infection like vivax malaria.
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