A 9-year-old girl presented to our outpatient department with fever, yellowish discoloration of sclera, and abdominal distension since one-and-a-half month. There was no significant past or family history. Pallor, icterus, ascites, and dilated veins over the abdomen were present on examination. Liver function test showed increased total and direct bilirubin 13.8 mg/dL (0.3-1.2 mg/dL) and 8.4 mg/dL (0.1-0.2 mg/dL), hypoalbuminemia (total protein : 40 g/L (64-81 g/L); albumin: 20 g/L (35-50 g/L)), and deranged coagulation tests (prothrombin time of 40/11 s and activated partial thromboplastin time of 90/27 s).An ophthalmic examination revealed bilateral Kayser-Fleischer rings. Serum ceruloplasmin, on further workup, was decreased to 8.8 mg/dL (20-60 mg/dL).Ultrasound abdomen showed features of cirrhosis; that is, liver span was 9 cm with coarse echotexture and irregular margins. All these findings suggested that the patient had cirrhosis secondary to an unrecognized advanced case of Wilson's disease.Further hematology workup showed the following: hemoglobin: 89 g/L (120-160 g/L); total leukocyte count: 17.6 9
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.