Hepatitis during respiratory syncytial virus infection – a case report

Abstract

Introduction:Respiratory syncytial virus (RSV) infection is the most common cause of hospitalization in infants and small children. The aim was to present a 13-months old boy diagnosed with acute airway infection, acute otitis media (AOM) and hepatitis during the RSV-infection.Material and methods:Serum catalytic activities of alkaline phosphatase (ALP), aspartate aminotranspherase (AST), alanine aminotranspherase (ALT), gamma glutamyl transpherase (GGT), lactate dehydrogenase (LD), and concentrations of bilirubin were monitored during hospitalization and at control examination.Results:The child had clinical signs and symptoms of respiratory failure, AOM, and laboratory findings of virus infection and liver disease. On admission, catalytic activities of enzymes were markedly increased, especially the activity of ALP (10333 U/L, i.e. 24-fold increase in comparison with the upper reference limit). The highest increased in AST (339 U/L, 4.5-fold), ALT (475 U/L, 10.3-fold) and LD (545 U/L, 1.5-fold) were registered on the 3rd day, and the highest increase in GGT (68 U/L, 3.1-fold) occurred on the 11th day. Seven weeks after discharge AST, ALT, GGT and LD decreased into reference range, and ALP remain mildly increased (478 U/L, 1.1 fold increase). RSV was confirmed in nasal lavage fluid.Conclusion:Laboratory results in patient with RSV infection needs to be interpreted in the light of both, respiratory and extrapulmonary manifestations of the infection, respectively.

Neurologic Alterations Due to Respiratory Virus Infections

“…However, in the past years, extrapulmonary manifestations have been associated with this virus (Eisenhut, 2006 ). Notably, there is evidence that relates hRSV infection with pathologies such as myocarditis (Esposito et al, 2010 ), hyponatremia (Hanna et al, 2003 ), hepatitis (Kirin et al, 2013 ) and encephalopathy (Ng et al, 2001 ). In Wallace and Zealley ( 1970 ), in a study performed in children with a febrile status, hRSV was detected, and its infection was related to neurological damage.…”

Atypical Presentations of Respiratory Syncytial Virus Infection: Case series

“…Acute fulminant hepatic failure with encephalopathy is another rare atypical manifestation of RSV infection. 15 Acute hepatitis can be a manifestation of other viruses such as the hepatitis, Epstein-Barr, cytomegalovirus and influenza viruses. One patient in this series (case one) had acute fulminant hepatic failure with encephalopathy and deranged coagulation.…”

Biomarkers of respiratory syncytial virus (RSV) infection: specific neutrophil and cytokine levels provide increased accuracy in predicting disease severity

“…To date, RSV RNA has been detected in peripheral blood mononuclear cells (PBMCs), cerebrospinal fluid (CSF), myocardium, primary nerve cells, the middle ear, the liver, and bone marrow [92-100]. Once seeded in these extrapulmonary sites RSV infection can cause a number of important secondary pathologies, such as sino-atrial blockade [101] or increased liver enzymes and hepatitis development [99], though the exact mechanisms behind these occurrences are not known. Similar to RSV, the recent finding of latent Mycobacterium tuberculosis infection within human bone marrow stem cells [102] supports the idea that the bone marrow may serve as a sanctuary for latent RSV infection from which persistent post-bronchiolitis airway dysfunction, failures in development of immunity to the virus, and possibly even later reactivation arise [103].…”