Human Parechovirus as a Cause of Isolated Pediatric Acute Liver Failure

• Published in: Pediatrics (Evanston) Vol. 138; no. 5
• Main Authors: Bigelow, Amee M, Scott, John P, Hong, Johnny C, Cronin, David C, Vitola, Bernadette E, Fons, Roger A, Petersen, Tara L
• Format: Journal Article
• Language: English
• Published: United States 01.11.2016
• Subjects: Female; Humans; Ileal Diseases - etiology; Ileal Diseases - surgery; Infant; Intussusception - etiology; Intussusception - surgery; Jejunal Diseases - etiology; Jejunal Diseases - surgery; Liver Failure, Acute - surgery; Liver Failure, Acute - virology; Liver Transplantation; Parechovirus - isolation & purification; Picornaviridae Infections - complications; Picornaviridae Infections - diagnosis; Postoperative Complications; RNA, Viral - blood
• DOI: 10.1542/peds.2016-0233

Among infants, almost half of acute liver failure cases are classified as indeterminate, whereas only a small number of cases show a documented viral infection. We present the first reported case of isolated acute hepatic failure in an infant in the setting of a human parechovirus (HPeV) infection. HPeV also may have been contributory to the posttransplant complication of 2 intussusceptions. This is a 10-month-old girl who presented with only symptoms of fussiness and was noted to have progressive decline in synthetic liver function as well as worsening coagulopathy requiring a liver transplant. The acute liver failure was in the setting of a positive serum RNA HPeV, subtype 3 (HPeV-3), after extensive diagnostic testing with genetic, autoimmune, and infectious causes otherwise negative. After liver transplantation, the postoperative course was complicated by both an ileal-ileal intussusception as well as a jejunal intussusception. Viral testing in pediatric acute liver failure is often performed, but the workup is frequently incomplete. This case report would support more extensive viral testing in this population of patients. In the setting of HPeV, clinicians could be alerted to the possibility of delayed gastrointestinal pathology in the posttransplant phase. Wider use of routine HPeV testing may more clearly define the variable clinical presentations and outcomes.