Cholestatic jaundice in pediatric covid-19: two case reports

CASE REPORTS

Cholestatic Jaundice in Pediatric COVID-19: two case reports

Karen Janice Moras, Suneel C Mundkur, Rochelle Anne Periera.

Department of Pediatrics, Kasturba Medical College, MAHE, Manipal University, Manipal, India.

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Abstract
Hepatic involvement in COVID-19 in children is typically characterized by elevation in Alanine transaminase (ALT) and Aspartate aminotransferase (AST) with preserved liver synthetic function.1 Severe hepatic involvement in COVID-19 is seen in COVID Multisystem Inflammatory Syndrome in Children (MIS-C), which typically occurs several weeks to months after the initial SARS-CoV-2 infection rather than during acute infection.(2, 3) However, there is a paucity of literature describing Paediatric cases of cholestatic jaundice as a primary manifestation of acute SARS-CoV-2 infection. We report two cases of cholestatic jaundice as the primary manifestation of COVID-19.

Why this article important?

Cholestatic jaundice in children is commonly seen in the neonatal period. The common causes in childhood are viral hepatitis, Wilson's disease, Autoimmune hepatitis, connective tissue disorders etc. The two children in the case report presented after the period of the COVID-19 pandemic when testing for the virus was not easily accessible. All the other causes of jaundice like Wilson’s disease, autoimmune hepatitis,viral hepatitis secondary to hepatotropic viruses like Hepatitis A, B, C, E, SLE, Reyes syndrome were ruled out. The Alanine and aspartate transaminase elevation has been reported in COVID -19 Literature. The prolonged course of cholestatic jaundice has not been previously reported

Summary of article

The SARS-CoV-2 virus has had catastrophic implications for humankind. There have been myriad presentations from asymptomatic to sudden death. The most common presenting features have been the respiratory, and central nervous systems. The hepatobiliary system has not been much involved in COVID-19 infection. The transient elevation of Alanine transaminase and aspartate transaminases was the most common biochemical finding in Pediatric COVID-19. The two children reported had history of atopic dermatitis. This might have had an impact on the immune response of the host, predisposing them to COVID-19 infection .We report 2 cases of prolonged course of Cholestatic jaundice in children

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