Fevers, colds, and gastric issues have become common now, what with the sudden spike in viral infections.
But this four-year-old’s frequent fever spikes and bouts of vomiting, which the parents initially thought was just a viral infection, became something uncommon.
Diagnosis: Virus-induced acute liver failure!
Needless to say that Reena’s parents were shocked to find out that their daughter had developed acute liver failure at such a young age.
Reena, a resident of Bengaluru’s outskirts, was a healthy child until recently, when she started experiencing symptoms of fever and vomiting. When her symptoms didn’t let up, her parents, who own a small business, took her to a nearby nursing home.
The little girl did not show any signs of improvement even a day after treatment started and she was referred to SPARSH Hospital as she needed intensive care.
“We realised the situation was complex only after she was admitted to Yeshwantpura’s SPARSH Hospital. She had high fever, vomiting, drowsiness, and intermittent irritability,” explained doctors at SPARSH Hospital.
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What happened to Reena?
Reena’s health condition deteriorated rapidly and blood tests were performed. On initial assessment, the doctor found her liver test results grossly abnormal, with SGOT and SGPT levels far exceeding the normal range.
Also, her clotting parameters were significantly outside the normal range, indicating that her blood was not clotting properly.
“These parameters are typically associated with acute liver failure, a life threatening condition that often requires a liver transplant or that could result in death if not referred to a specialised liver centre on time,” explained Dr Naveen Ganjoo, Consultant in Hepatology & Liver Transplantation, SPARSH Hospital.
On further examination, it was found that Reena was infected with adenovirus, a type of virus that has been causing infections in the eyes, stomach, and respiratory system in endemic proportions.
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Reena’s recovery
Reena’s blood tests showed signs of recovery after 24-48 hours, but her kidney function continued to worsen. The medical team performed a CT scan to assess whether there was any swelling in her brain, and fortunately, there was none.
However, her lungs were found to be filled with fluid, which could soon affect her breathing. To avoid putting her on a ventilator, the team started treating her for the fluid in her lungs.
With careful attention and support to her organs, her liver function parameters slowly normalised and her condition gradually improved.
Adenovirus-induced liver failure can be challenging for families to accept because it leads to sudden complications and it can be difficult to determine the cause. Aggressive management in a dedicated paediatric liver unit can lead to better outcomes and decreased mortality and morbidity.
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While some kids recover with medical management alone, others may require a liver transplant. In many cases, the cause of acute liver failure cannot be determined, but it can be due to infections, drugs, metabolic disorders, immune-related conditions, and other factors.
Said Dr Ganjoo: “The key to treating acute liver failure is early recognition and prompt referral to a specialised centre that is equipped to handle complex cases. We were thrilled to see Reena recover without having to go through a liver transplant,” he added.
Adenovirus & the rise in cases
Doctors told South First that Reena’s case is a classic example of how adenovirus can induce liver failure. This has brought attention to the potential dangers of this often-overlooked virus.
Adenoviruses are a group of viruses that can cause a range of illnesses, from cold-like symptoms to more severe conditions such as pneumonia and liver failure. While most adenovirus infections are mild and self-limiting, some cases can lead to life-threatening complications, as seen in Reena’s case, explained the doctors at SPARSH.
Doctors at SPARSH said that over the last few weeks, about 12,000 cases of adenovirus infections were reported in West Bengal and more than 3,000 children were hospitalised with flu-like symptoms. Meanwhile, in Karnataka, there has been a rise in the number of adenovirus cases, with approximately 37 cases recorded in the last few weeks.
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How can adenovirus induce liver failure?
Adenovirus-induced liver failure is a rare but potentially deadly complication of the virus. It occurs when the virus infects liver cells, causing inflammation and damage to the liver.
In severe cases, the liver can fail, leading to a build-up of toxins in the bloodstream and the potential for multiple organ failure. In such cases, the virus spreads from the respiratory or gastrointestinal tract to the liver, critically damaging it.
Liver failure occurs when the liver is no longer able to function properly. The liver is responsible for a wide range of critical functions, including detoxifying the blood, producing bile to aid in digestion, and synthesising important proteins such as clotting factors.
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Symptoms & treatment of adenovirus-induced liver failure
The symptoms of adenovirus-induced liver failure can be subtle at first, but can progress rapidly if left untreated. These symptoms can include jaundice (yellowing of the skin and eyes), abdominal pain, nausea and vomiting, fatigue, and confusion or difficulty concentrating.
Treatment for adenovirus-induced liver failure typically involves supportive care, such as monitoring vital signs, providing intravenous fluids and nutrition, and administering medications to manage symptoms. In severe cases, a liver transplant may be necessary.
Fortunately, early diagnosis and treatment can improve outcomes for patients with adenovirus-induced liver failure.
Dr Anil MU, Consultant Paediatrician and Paediatric Intensivist, SPARSH Hospital, said, “There has been a noticeable increase in the number of adenovirus cases in children. They often exhibit high fever, eye redness, cold, and cough symptoms. Although it is typically a self-limiting illness, it can occasionally result in rare complications such as acute liver failure.”
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Complicated diagnosis of virus-induced liver failure
Dr Anil explained to South First that the diagnosis of acute liver failure can be challenging for families to accept because it leads to sudden complications and it progresses rapidly.
“It is of utmost importance to refer the patient to a specialised centre that is equipped with a multidisciplinary team to handle complex cases like this,” he explained.
Dr Anil, citing Reena’s case, said, “Our team was well-prepared for any potential complications and were ready to take swift action if there were any unexpected developments. Over a course of 10 days, Reena responded to our medications and she is now on the path to recover.”
In Reena’s case, the medical team at SPARSH worked closely with her family, informing them of the seriousness of the situation and advising them that the girl might need a liver transplant, if she does not recover quickly.
The medical team worked towards correcting all her parameters and gave her medication and blood products to restore her clotting mechanism and created an environment for her liver to regenerate.
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Which viruses can cause liver failure?
There are several viruses that can cause liver failure, including hepatitis A, B, C, D, and E viruses. Additionally, some adenoviruses have also been known to cause liver failure in rare cases.
Dr Naveen added that in many cases, the cause of acute liver failure cannot be determined, but it can be due to infections, drugs, metabolic disorders, immune-related conditions, and other factors.
He stressed that, “In these circumstances, liver transplant is the standard of care but we should always try our best to save patients and leave no stones unturned.”
