Acute Liver Failure and Aplastic Anemia in an 11-Year-Old Girl

Excerpt

An 11-year-old previously healthy female presented with a 1-week history of jaundice and fatigue. Her aspartate aminotransferase (AST) level was 1,420 U/L, alanine aminotransferase (ALT) 1,044 U/L, total bilirubin 16.5 mg/dL and international normalized ratio (INR) for prothrombin time 1.2. Complete blood count showed a white blood count of 7,700/mm³, hematocrit 40.6 g/dL, and platelet count 509,000/mm³. Ultrasound demonstrated mild hepatomegaly but was otherwise normal. Serology was negative for hepatitis A, B, and C and Epstein-Barr virus (EBV) and cytomegalovirus (CMV). After discharge, she was followed by her outpatient pediatric gastroenterologist, who noted that she continued to have jaundice and elevated aminotransferase levels. A liver biopsy was recommended, but her parents refused, and the patient was lost to follow-up for several months. …