Clinicopathological characteristics of 3 probable pediatric cases with acute severe hepatitis of unknown aetiology

Meiling Li; Lina Jiang; Shuhong Liu; Pengfei Xu; Haiyan Wei; Yu Li; Chaonan Guo; Li Zhu; Bokang Zhao; Yisi Liu; Min Zhang; Jingmin Zhao

doi:10.1016/j.nmni.2023.101203

Clinicopathological characteristics of 3 probable pediatric cases with acute severe hepatitis of unknown aetiology

New Microbes New Infect. 2023 Dec 1:56:101203. doi: 10.1016/j.nmni.2023.101203. eCollection 2024 Jan.

Authors

Meiling Li¹, Lina Jiang¹, Shuhong Liu¹, Pengfei Xu¹, Haiyan Wei¹, Yu Li¹, Chaonan Guo¹, Li Zhu¹, Bokang Zhao², Yisi Liu³, Min Zhang¹, Jingmin Zhao¹

Affiliations

¹ The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
² Department of Hepatology, Center of Infectious Diseases and PathogenBiology, The First Hospital of Jilin University, Changchun, China.
³ First Department of Liver Disease Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.

Abstract

Background: Acute severe hepatitis with unknown aetiology in children (ASHep-UA) has become a global health alert. This article reported clinicopathological characteristics of 3 probable ASHep-UA cases.

Methods: We respectively collected serological data and liver biopsies of 3 suspected cases of ASHep-UA. Neutralizing antibodies titer for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variants were determined by virus neutralization test (VNT). Histological assessment, immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) for cytomegalovirus (CMV), Epstein-Barr virus (EBV), human adenoviruses (HAdV), adeno-associated virus (AAV2), human herpes virus type 6 (HHV-6) were performed to identify possible aetiologies.

Results: Remarkable elevation of transaminase (median ALT level, 1100 IU/liter; median AST level, 500 IU/liter) were revealed with undetectable hepatitis A-E and non-hepatotropic virus in both sera and tissues. Weakness, jaundice, pale stools and splenomegaly were observed. Interestingly, two individuals had SARS-CoV-2 Omicron variants infection. Histologically, moderate or severe lobular necroinflammation, active interface hepatitis and portal inflammatory infiltrate with lymphocytic, plasma cells, neutrophils and eosinophilic cells were noted.

Conclusions: The exact aetiology of ASHep-UA was still unknown. By reporting the 3 probable cases, we expect to enrich the clinical experience in diagnosis and treatment of ASHep-UA as well as the pathological characteristics.

Keywords: Acute severe hepatitis; Children; Clinicopathological characteristics; Unknown aetiology.