Alteration of liver function due to H1N1 infection: a case report
A 22-month-old male was admitted to our hospital due to fever and cough. The fever was subjective and intermittent for 4 days. The cough was described as dry and of 5 days duration. There was no vomiting, diarrhea, rash, or seizures. The mother denied witnessing any ingestion of acetaminophen or toxic material. Past medical history and family medical history were unremarkable. Immunization, including influenza/H1N1, was reported as up to date per parents.\nVitals on admission were as follows: temperature 39°C, respiratory rate 50 breaths per minute, blood pressure 100/70 mmHg, pulse rate 110 beats per minute, oxygen saturation 90% in room air, weight 12.3 kg (50th percentile), height 88 cm (75th percentile), and head circumference 48.2 cm (50th percentile).\nOn examination, the child was drowsy; oral mucosa was dry; pharynx was erythematous with no associated cervical lymphadenopathy; the respiratory exam showed bilateral diffuse coarse crepitations and no wheezing; the abdomen was soft and mildly distended, with audible bowel sounds; the liver was palpated 3 cm below the right costal margin, with possible tenderness in the right upper quadrant, but there was no rebound. The rest of the physical exam was unremarkable.\nInitial laboratory investigations were as follows: complete blood count showed a white blood count of 3,500/uL, hemoglobin 12.5 g/dL, platelets of 195,000/uL; erythrocyte sedimentation rate 17 mm/hour; creatinine of 66 umol/L, albumin 25 g/L, alanine aminotransferase (ALT) 2,106 U/L, aspartate aminotransferase (AST) 850 units/L, alkaline phosphatase (ALP) 291 units/L, gamma glutamyl transferase (GGT) 107 units/L, and total bilirubin 13 umol/L; the rest of the chemistry results were unremarkable, as were the coagulation profile, ammonia, and lactate. His venous blood gas was pH 7.2, carbon dioxide partial pressure (pCO2) 44 mmHg, partial pressure of oxygen (pO2) 29 mmHg, bicarbonates (HCO3) 17 mEq/L, with a base excess of 11. Polymerase chain reaction (PCR) was conducted on the nasopharyngeal secretion and was positive for H1N1. Cerebrospinal fluid studies were normal, and urine and blood culture did not grow any organisms. Hepatitis A immunoglobin (Ig)-M was negative, hepatitis B surface antigen and core antibody were negative, hepatitis B surface antibodies were positive, and hepatitis C IgM was negative. Furthermore, and because of the fever and mildly enlarged liver, PCR was conducted on a blood sample to check for herpes simplex virus, adenovirus, Epstein–Barr virus, and cytomegalovirus; results were negative.\nA chest radiograph showed bilateral streaky infiltrates with no focal consolidation. An ultrasound of the abdomen showed mild coarse hepatic echo texture with no focal lesion.