Approach to Clinical Syndrome of Jaundice and Encephalopathy in Tropics

Hepatobiliary Quiz (Answers)—16 (2015)

“…It involves the deposition of unconjugated bilirubin into the cortical gray matter, predominantly the basal ganglia. 30,31 Most common cause is a hemolytic anemia, usually due to Rh or ABO incompatibility. The risk of developing bilirubin encephalopathy is higher in neonates with low birth weight, hypothermia, anoxia, acidosis, sepsis, hypoalbuminemia, and meningitis.…”

“…30,34 It may be primary (genetic), or secondary (acquired) to viral infections, autoimmune diseases or malignancies. It occurs secondary to excessive inflammation by a lack of normal downregulation of activated macrophages and lymphocytes.…”

“…The most common infectious trigger is viral infection, especially Epstein-Barr virus. 30 Clinically, the patients present with fever, hepatosplenomegaly, lymphadenopathy, jaundice (in more than 2/3 cases), and maculopapular rash. Neurological manifestations are seen in nearly half of the cases: encephalopathy, meningismus, and seizures are the most common.…”

Hepatobiliary Quiz (Answers)—14 (2015)

“…As many of these patients have severe immunodeficiency, altered sensorium is frequently seen, thereby mimicking features of liver failure. 72,73 …”

Uncommon cause of acute liver failure with encephalopathy

“…The hepatic involvement in tropical infections can range from mild, transient elevation in enzymes to acute liver failure (ALF). [ 1 ] Herein, we present a case of ALF with encephalopathy caused by scrub typhus.…”