CONGENITAL VIRAL HEPATITIS A WITH A FATAL OUTCOME

Background. Intrauterine HAV transmission and congenital hepatitis A (HA) are rarely reported. Most infants born to mothers with HAV infection are uninfected and have normal transaminase levels. According to the literature, lethal outcomes with congenital HA have either not been recorded or are a rare occurrence. Objective. To present a description of a clinical case of acute HA in a pregnant woman and congenital HA in a fetus with a fatal outcome in the newborn. Material and methods. A diabetic female patient who suffered an icteric form of acute HA at the gestational age of 25-29 weeks and underwent cesarean delivery at the gestational age of 36 weeks (253 days) due to fetal indications. An analysis of patient’s clinical, laboratory as well as instrumental findings was carried out. Autopsy data of a newborn child died due to congenital HA were studied. Results. It was established that during acute moderate HA course in the pregnant woman with diabetes-related microangiopathy and polyneuropathy there occurred transplacental HAV infection of the fetus with the development of congenital HA. Morphologically, hepatitis was characterized by predominance of alterative changes in hepatocytes, as well as pronounced intralobular cholestasis, exudation and proliferation being moderately expressed. Conclusion. Diabetes mellitus contributed both to HAV infection, the development of acute HA in the woman in the second trimester of pregnancy, and damage to the fetus by HAV infection. The causes of the child’s death were severe asphyxia due to diabetic embryo- and fetopathy, placental disorders and multiple organ failure due to the abovementioned diseases, acute liver failure, intrahepatic cholestasis caused by congenital acute HA.