So I recently transferred to peds at a large urban pediatric hospital, and there is this liver pt that has us all stumped.
3 yo male, previously healthy, born at 37 weeks, jaundiced when born but no bili lights used, paternal family hx of autoimmune (psoriasis/eczema/allergies), paternal and maternal family hx of Gilberts syndrome, maternal hx of pre-eclampsia with pt. Presented to ED 8/27 jaundiced, acholic stool, dark urine, abdominal pain.
Labs 8/27:
*AST 4424
*ALT 3039
*Alk Phos 312
*Unconj bili: 0.8
*Conj bili: 5.4
*INR 1.03
Pt was dc after 2 days, returned to ED 9/3:
*AST 5360
*ALT 3558
*Alk Phos 280
*Unconj bili: 2.0
*Conj bili: 12.2
*INR 1.13
Ultrasound 9/4 found a gallstone MRCP 9/4 noted gallstone. Noted gallbladder wall appears thickened, no other abnormalities.
Labs from today show bili around 24, AST/ALT at levels similar to 9/3 levels, INR remains at 1.13.
Negative for:
*PR3
*Myeloperoxidase
*Adenovirus
*Parvo
*A1A deficiency
*ASMA
*Wilsons
*Anti-LKM-1
*VZV IGM and IGG
*tTg 3.4
*IgG normal
The patient has c/o abd pain at home. Some vomiting/diarrhea at home. Afebrile, appetite remains good, not fatigued.
Surely a virus process going on?? Not sure. Sorry if this breaks the rules of the sub, I am just curious about this one.
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