Hepatitis A Virus Complicated by Macrophage Activation Syndrome in Children: A Case Report - EAP 2021 Virtual Congress and MasterCourse

Siham Si Merabet ^1,2,3 Fatima Souhila Bouchama ^1,2,3 Safia Zoubir ^1,4 Kamel Elhalimi ^1,2,5

¹Faculty of Medicine of Oran, University Oran 1, Oran, Algeria
²Research Laboratory in Pediatric Accidentology, University Oran 1, Oran, Algeria
³Pediatric Anesthesiology and Intensive Care Unit, Pediatric Etablissement Specialized Hospital of Canastel Oran, Oran, Algeria
⁴Pediatric Emergency Department, University Hospital Center of Oran, Oran, Algeria
⁵Pediatric Intensive Care Unit, University Hospital Center of Oran, Oran, Algeria

Introduction: Macrophage Activation Syndrome (MAS) is potentially life-threatening complication that can worsen the prognosis of infection, cancer or autoimmune disease. Hepatitis A virus is a very rare cause of secondary MAS.

Objective: Report a case of MAS that occur in pediatric patient and describe it clinical and therapeutic features

Methods: We recorded a 5,5 year-old girl hospitalized in our pediatric hospital for hepatitis A virus.

Observation : In this case report, we registered a school age child without a past medical history who presented with serologically confirmed hepatitis « A », the evolution despite treatment was marked by the persistence of cholestatic jaundice for more than a month and recurrence of a fever hence its readmission for investigations. She was Clinicaly malnourished with a jaundice, persistence of fever at 39 ° C, abdominal pain and hepatomegaly. Laboratory examinations showed : Hemoglobin 5.6g / dl, White blood cells 2100 / mm3 Platelets 96000 / mm3, Fibrinogen 1.57 g / l, TP 40%, TCK 76, 5 sec, Ferritinemia > 1200ng / ml, LDH 4664IU / l. Viral serologies was positive for hepatitis A and negative for HIV, HCV, HBS, syphilis as well as Wilson`s disease peripheral blood smear: confirmed leukopenia, 5% erythroblastosis with no invasion. Bone-marrow aspiration rule out malignant hematologic disease and an infectious process . CD25> 7500U / l, hypergammaglobulinemia, NK CD3 CD56 79 elements / mm3. hepatosplenomegaly on ultrasound
The management consisted of : anti-infectious treatment (imipenem, vancomycin, gentamycin, metronidazol, fluconazol), 2 boluses of corticosteroid therapy, immunoglobulin. with fluid, electrolyte and haematological resuscitation.
The outcome of MAS has been favorable.

Conclusion: MAS associated with the virus is a potentially life-threatening disease, early diagnosis and treatment was mandatory. It must be sought in front of any suspected clinical and biological feature.