Skip to main content

Advertising Disclaimer »

Main menu

  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors
    • Submit Manuscript
    • Author Guidelines
  • Content
    • Current Issue
    • Complete Issue PDF
    • Archive
    • Topic/Program Collections
    • Blog
  • Multimedia
    • Teaching Slides
    • Pediatrics On Call Podcast
  • CME/MOC
    • CME Quizzes
    • MOC Claiming
  • Subscribe
  • Alerts
  • Careers
  • Other Publications
    • American Academy of Pediatrics

User menu

  • Log in
  • My Cart

Search

  • Advanced search
American Academy of Pediatrics

AAP Gateway

Advanced Search

AAP Logo

  • Log in
  • My Cart
  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors
    • Submit Manuscript
    • Author Guidelines
  • Content
    • Current Issue
    • Complete Issue PDF
    • Archive
    • Topic/Program Collections
    • Blog
  • Multimedia
    • Teaching Slides
    • Pediatrics On Call Podcast
  • CME/MOC
    • CME Quizzes
    • MOC Claiming
  • Subscribe
  • Alerts
  • Careers
American Academy of Pediatrics
Index of Suspicion

Case 6: Liver Failure and Rash in a 6-week-old Girl

Rishi Mediratta, Hayden Schwenk, Anoop Rao and Ritu Chitkara
Pediatrics in Review June 2018, 39 (6) 315; DOI: https://doi.org/10.1542/pir.2017-0019
Rishi Mediratta
*Department of Pediatrics,
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Hayden Schwenk
†Division of Pediatric Infectious Diseases, and
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Anoop Rao
‡Division of Neonatal-Perinatal Medicine, Stanford University School of Medicine, Stanford, CA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ritu Chitkara
‡Division of Neonatal-Perinatal Medicine, Stanford University School of Medicine, Stanford, CA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • Comments
Loading

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Download PDF
  1. Rishi Mediratta, MD, MSc, MA*
  2. Hayden Schwenk, MD, MPH†
  3. Anoop Rao, MD‡
  4. Ritu Chitkara, MD, FAAP‡
  1. *Department of Pediatrics,
  2. †Division of Pediatric Infectious Diseases, and
  3. ‡Division of Neonatal-Perinatal Medicine, Stanford University School of Medicine, Stanford, CA
  • AUTHOR DISCLOSURE

    Drs Mediratta, Schwenk, Rao, and Chitkara have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 6-week-old girl is admitted to the NICU with liver dysfunction and jaundice. One week before presentation she had developed an erythematous macular rash on the chest and extremities, oral thrush, and a low-grade fever. Physical examination reveals jaundice, hepatosplenomegaly, and a desquamating macular rash on the left lower extremity. Her vital signs are normal for age. She was born to a 34-year-old G7P2321 woman via normal spontaneous vaginal delivery at 37 weeks' gestation. Birthweight was 3,060 g (35th percentile). The infant’s mother had routine prenatal care, and her course was complicated by intrahepatic cholestasis of pregnancy. Results of first-trimester maternal Treponema pallidum enzyme immunoassay were negative.

Laboratory evaluation reveals acute liver failure, coagulopathy, conjugated hyperbilirubinemia, lymphocyte-predominant leukocytosis, disseminated intravascular coagulation, anemia, and thrombocytopenia. Laboratory test results are notable for hemoglobin level, 7.2 g/dL (72 g/L); total leukocyte count, 25,000/μL (25.0 × 109/L) with 68% lymphocytes and 18% neutrophils; platelet count, 20 × 103/μL (20 × 109/L); aspartate aminotransferase, 1,164 U/L (19.4 μkat/L); alanine aminotransferase, 536 U/L (8.9 μkat/L); albumin, 1.8 g/dL (18 g/L); international normalized ratio, 1.8; and partial thromboplastin time, 34.9 seconds. Her C-reactive protein level was elevated at 19.1 mg/L (181.9 nmol/L).

Discussion

The differential diagnosis includes sepsis due to bacteria such as Escherichia coli, Enterococcus, Klebsiella, methicillin-resistant Staphylococcus aureus, and T pallidum. Potential viral pathogens include enterovirus, echovirus, adenovirus, parvovirus, Epstein-Barr virus, cytomegalovirus, herpes simplex virus (HSV), human immunodeficiency virus (HIV), human herpesvirus 6, and other viral hepatitides. Noninfectious possibilities include α1-antitrypsin deficiency, hemophagocytic lymphohistiocytosis, and acetaminophen toxicity.

Treatment with vancomycin, …

Individual Login

Log in
You will be redirected to aap.org to login or to create your account.

Institutional Login

via Institution

You may be able to gain access using your login credentials for your institution. Contact your librarian or administrator if you do not have a username and password.

Log in through your institution

If your organization uses OpenAthens, you can log in using your OpenAthens username and password. To check if your institution is supported, please see this list. Contact your library for more details.

Purchase access

You may purchase access to this article. This will require you to create an account if you don't already have one.

Offer Reprints

PreviousNext
Back to top

Advertising Disclaimer »

In this issue

Pediatrics in Review: 39 (6)
Pediatrics in Review
Vol. 39, Issue 6
1 Jun 2018
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by author
  • Complete Issue (PDF)
View this article with LENS
PreviousNext
Email Article

Thank you for your interest in spreading the word on American Academy of Pediatrics.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Case 6: Liver Failure and Rash in a 6-week-old Girl
(Your Name) has sent you a message from American Academy of Pediatrics
(Your Name) thought you would like to see the American Academy of Pediatrics web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Request Permissions
Article Alerts
Log in
You will be redirected to aap.org to login or to create your account.
Or Sign In to Email Alerts with your Email Address
Citation Tools
Case 6: Liver Failure and Rash in a 6-week-old Girl
Rishi Mediratta, Hayden Schwenk, Anoop Rao, Ritu Chitkara
Pediatrics in Review Jun 2018, 39 (6) 315; DOI: 10.1542/pir.2017-0019

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Case 6: Liver Failure and Rash in a 6-week-old Girl
Rishi Mediratta, Hayden Schwenk, Anoop Rao, Ritu Chitkara
Pediatrics in Review Jun 2018, 39 (6) 315; DOI: 10.1542/pir.2017-0019
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
Print
Download PDF
Insight Alerts
  • Table of Contents

Jump to section

  • Article
    • Presentation
    • Discussion
    • References
  • Info & Metrics
  • Comments

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Dysphagia and Epigastric Pain in an Adolescent Boy
  • Refusal to Use an Upper Extremity in a 17-month-old with Facial Nerve Palsy
  • Forehead Swelling and Fever in a 12-year-old Ugandan Boy
Show more Index of Suspicion

Similar Articles

Subjects

  • Infectious Disease
    • Sexually Transmitted Infections
    • Infectious Disease
  • Fetus/Newborn Infant
    • Fetus/Newborn Infant
  • Journal Info
  • Editorial Board
  • ABP Content Specifications Map
  • Overview
  • Licensing Information
  • Authors
  • Author Guidelines
  • Submit My Manuscript
  • Librarians
  • Institutional Subscriptions
  • Usage Stats
  • Support
  • Contact Us
  • Subscribe
  • Resources
  • Media Kit
  • About
  • International Access
  • Terms of Use
  • Privacy Statement
  • FAQ
  • AAP.org
  • shopAAP
  • Follow American Academy of Pediatrics on Instagram
  • Visit American Academy of Pediatrics on Facebook
  • Follow American Academy of Pediatrics on Twitter
  • Follow American Academy of Pediatrics on Youtube
American Academy of Pediatrics

© 2021 American Academy of Pediatrics