Hypoxic hepatitis as a complication of newly diagnosed type 1 diabetes in a teenager.
Kamil BuczkowskiIrena Ożóg-ZabolskaJacek GulczyńskiEwa Iżycka-ŚwieszewskaPublished in: Autopsy & case reports (2022)
Hypoxic hepatitis is a rare complication of type 1 diabetes with unknown prevalence in Pediatrics. We present a case report of an 11-year-old boy admitted to the ER in the spring of 2020 (the beginning of the COVID19 pandemic in Poland) due to nausea, abdominal pain, and weight loss. A diagnosis of type 1 diabetes accompanied by severe ketoacidosis (pH 6.9, blood glucose 632mg/dl, ketone bodies in urine - 150mg/dl) was made. The hyperglycemia, ketoacidosis, and water-electrolyte disturbances were treated in the Pediatric Intensive Care Unit. On day 4, the boy developed fulminant septic shock with high aminotransferases (AST 9026 U/l, ALT 3559 U/l). CT scan revealed hepatic enlargement and steatosis. Acute viral hepatitis was suspected. The levels of anti-CMV IgM and IgG antibodies were slightly elevated. At autopsy, the liver was enlarged, with petechial bleedings on the surface. The liver parenchyma was congested, with signs of steatosis. Microscopically, there was extensive centrilobular necrosis, acute passive sinusoidal congestion, and steatosis of hepatocytes. There were no signs of CMV infection. Based on the entire clinicopathological picture, the patient was diagnosed with hypoxic hepatitis, complicated by septic shock and multiple organ failure.
Keyphrases
- septic shock
- blood glucose
- liver failure
- insulin resistance
- intensive care unit
- type diabetes
- newly diagnosed
- glycemic control
- weight loss
- high fat diet
- computed tomography
- abdominal pain
- drug induced
- high fat diet induced
- risk factors
- liver injury
- bariatric surgery
- magnetic resonance imaging
- sars cov
- young adults
- blood pressure
- case report
- skeletal muscle
- hepatitis b virus
- early onset
- body mass index
- pulmonary embolism
- positron emission tomography
- dual energy
- ionic liquid
- image quality
- contrast enhanced
- extracorporeal membrane oxygenation
- diabetic rats
- acute respiratory distress syndrome