Question
A 10 years old girl presented to us with jaundice for 10 days and fever for 3 days. On examination, there was icterus, purpura, ecchymoses, anemia and firm liver of 6-7 cm below costal margin {which made us think of acute on chronic liver disease}. There was no lymphadenopathy or splenomegaly. Her hemoglobin was 5.2 g, total count 1000 and platelet count was 3000. KF ring was positive on Slit lamp examination but ceruloplasmin and urinary copper were not suggestive of Wilson’s. Peripheral smear showed no evidence of hemolysis. All hepatitis viral markers including hepatitis A,B,C were negative. ANA – negative. Her bilirubin was 8.2 with direct of 4.2. Liver transaminases were elevated 1200 and 1100. Serum albumin, PT, PTT were normal. Bone marrow aspiration done at 2 centres showed hypoplastic marrow. Bone marrow biopsy was not done. Other autoimmune hepatitis markers awaited and parvovirus serology is awaited. We thought initially as autoimmune hepatitis or parvovirus induced bone marrow suppression or infection induced suppression. She was started on methylprednisolone but her counts kept on going down. TLC- 750 and platelets – 2000. We stopped steroids and she is on taxim and amikacin. She is too stable for her condition.