Evaluation of Acute Severe Hepatitis of Unknown Origin in Three Children in Iran: A case series

According to the World Health Organization, the incidence of severe acute hepatitis of unknown origin in children is increasing worldwide. However, there are no known causes and treatments to deal with this disease. This study presents three children with severe acute hepatitis of unknown origin in a hospital medical center in Iran.

Two 12-year-old children and a six-year-old child were admitted to the hospital with jaundice. Laboratory tests showed markedly elevated liver enzymes and total and direct bilirubin in these patients. However, hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) antibodies (Ab), hepatitis A virus (HAV) IgM, HEV IgM, Epstein-Barr virus (EBV) IgM, anti-microsomal Ab, anti-liver kidney (LKM Ab), anti-smooth muscle antibodies (ASMA), anti-nuclear antibodies (ANA), and total IgG were all negative. After excluding the probable infectious causes of acute hepatitis and per the progressive course of fulminant hepatic failure, intravenous methylprednisolone was started for two of three cases during hospitalization. These children were discharged from the hospital in good general condition, and the liver function tests gradually decreased and approximated to near normal during the follow-up visits.

General practitioners and pediatricians are advised to examine the underlying causes and consider severe acute hepatitis of unknown origin when visiting children under 16 years with severe jaundice and very high transaminases.