Author Of 2 Presentations
ACUTE LIVER FAILURE IN AN INFANT SECONDARY TO EBV INFECTION - CASE REPORT
Abstract
Background
Epstein-Barr Virus (EBV) infection is often asymptomatic but it may exhibit various life threatening and atypical presentations. Acute liver failure (ALF) as a complication of EBV is very rare . We are presenting a case of an infant admitted with Acute gastroentertitis followed by septic shock and multiorgan dysfunction who went into ALF secondary to EBV infection in the recovery phase .
Objectives
To study clinical profile of a case of Acute Liver Failure secondary to EBV
Methods
A 10 month old child was referred to our centre with 1 week history of loose stools followed by respiratory failure and septic shock. On admission he was intubated and started on mechanical ventilation and ionotropes. Broad spectrum antibiotics were initiated empirically. He had multiorgan dysfunction with derranged LFTs, coagulation profile, encephalopathy and bicytopenia. Due to multisystem involvement Mycoplasma IgM was sent which came positive and Azithromycin was started. He was extubated on day 3 and was shiffted to ward. Around day 10, he was noticed to have jaundice with clay coloured stools. LFT showed direct hyperbilirubinemia, raised liver enzymes and INR. Etiological work up for liver failure showed elevated EBV viral load. New Born Screening Test was normal. Supportive measures for cholestatic jaundice were instituted after which, he started improving gradually and was discharged
Results
EBV reactivation causing acute liver failure is rare in infancy. Timely instituted supportive measures can reduce morbidity and moratliy
Conclusion
There should be a high index of suspicion of EBV infection in ALF cases in infancy though a rare occurence.
A CASE REPORT OF PERSISTENT METHEMOGLOBINEMIA SECONDARY TO ACUTE DAPSONE INTOXICATION
Abstract
Background
Dapsone (4,4 – diaminodiphenylsulphone) is used in various dermatological conditions and Pneumocystis carinii pneumonia. Accidental Dapsone overdose can lead to lifethreatening methhemoglobinemia (MethHb). We are presenting a case report on a toddler with symptomatic methemoglobinemia resistant to standard methylene blue treatment.
Objectives
To study the clinical profile and effectiveness of various treatment strategies in acquired Methemoglobinemia.
Methods
A 2.5 year old girl presented 12 hours after accidental ingestion of dapsone with irritability and central cyanosis with saturations in the 80s. Initial ABG showed normal paO2 levels, but Methemoglobin (MetHb) levels of 32%. Even after 2 bolus doses of methylene blue (G6PD status normal) and Ascorbic acid, she continued to be symptomatic with rebound increase in MetHb levels. Hence methylene blue infusion was started. In view of worsening metabolic acidosis, abnormal LFTs and hemolytic anemia, single volume exchange transfusion was done and high maintenance doses of Ascorbic acid was administered. There was dramatic clinical improvement with drop in methemoglobin levels. She was discharged on day 9, on methemoglobin levels of 5.4%.
Results
Failure of methylene blue therapy in this child might be due to inadequate decontamination, sulfhemoglobinemia or underlying hemoglobin M disease and might explain the response to whole blood exchange transfusion. Addition of ascorbic acid, an antioxidant, might have reduced the formation of new MetHb.
Conclusion
Methylene blue is the standard treatment for Methemoglobinemia. Failure to respond to this, warrants prompt initiation of alternate treatment strategies like exchange transfusion as well as high dose ascorbic acid administration.