A Case Report of Acute Liver Failure in a Child with Hepatitis a Virus and Epstein-Barr Virus Coinfection on the Background of Autoimmune Sclerosing Cholangitis

Sergiy Kramarov,1 Vitalii Yevtushenko,1 Iryna Seriakova,1 Oleksandr Voronov,1 Nataliia Kyrytsia,1 Liudmyla Vladislavivna Zakordonets,1 Valerii Shadrin,1 Claudia Shatrova,2 Nataliia Savostikova,3 Volodymyr Zhezhera3 1Department of Pediatric Infectious Diseases, Bogomolets National Medical University, Kyiv, Ukraine; 2Department of Morphology, Clinical Pathology and Forensic Medicine, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine; 3Сhildren’s Pathology Department, National Specialized Children’s Hospital Ministry of Health of Ukraine, Kyiv, UkraineCorrespondence: Iryna Seriakova, Assistant of the Department of Pediatric Infectious Diseases, Bogomolets National Medical University, Degtyarivska Street, 23, Kyiv, 04119, Ukraine, Email [email protected]: Fulminant hepatitis is a rare and severe form of acute liver failure (ALF) characterized by rapid and massive destruction of liver cells and associated with a high mortality rate. Infectious factors, in particular viral hepatitis, take a prominent place in the etiology of ALF, however, the presence of chronic liver pathology can play a significant role in the disease progression and development of ALF.Case Presentation: A 2-year-old child was hospitalized on the 4th day of the disease with manifestations of jaundice and general intoxication. The examination revealed markers of active hepatitis A virus infection and Epstein-Barr virus infection. From the seventh day of the disease, the child’s condition began to progressively deteriorate due to manifestations of ALF. Despite the use of immunomodulatory and replacement therapy, the disease ended fatally on the 9th day. Pathohistological examination revealed manifestations of viral necrotic hepatitis on the background of autoimmune sclerosing cholangitis.Conclusion: The case is novel as regards the occurrence of two viral hepatitis with different modes of transmission on a background of unidentified liver disease.Keywords: acute liver failure, fulminant hepatitis, viral hepatitis A, Epstein-Barr virus infection, children