Hypoxic hepatitis as a complication of newly diagnosed type 1 diabetes in a teenager

Buczkowski, Kamil; Ożóg-Zabolska, Irena; Gulczyński, Jacek; Iżycka-Świeszewska, Ewa

doi:10.4322/acr.2021.372

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Autopsy Case Report • Autops. Case Rep. 12 • 2022 • https://doi.org/10.4322/acr.2021.372 copy

Hypoxic hepatitis as a complication of newly diagnosed type 1 diabetes in a teenager

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

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.

Keywords
Hepatitis; Gastroenterology; Pediatrics; Diabetes Mellitus; Autopsy

Parameter	D1	D4	RR	Parameter	D1	D4	RR
pH	6.9	6.85	7.35-7.45	AST	10	9026	<38 U/l
K+	4.2	5.6	3.5-5.1 mmol/l	Ammonia	-	820.14	<102 ug/dl
Na+	142	139	132-141 mmol/l	Creatinine	1.04	2.01	<0.79 mg/d
Glucose	632	129	70-99 mg/dl	WBC	27,740	9,710	4,500-13,500 /µl
Lactic acid	18	216	5-14 mg/dl	Neutrophils	20,360	6,250	1,800-7,700/µl
CRP	3.12	130.07	<5 mg/l	PLT	409,000	49,000	140,000-420,000/µl
Procalcitonin	-	16.8	<0.5 ng/ml	APTT	20.2	66.5	25.4-36.9 sec.
Amylase	27	138	<91 U/l	PT	13.2	38	9.4-12.5 sec.
ALT	9	3559	<30 U/l	INR	1.16	>6	0.9-1.3

Hospital Universitário da Universidade de São Paulo Hospital Universitário da Universidade de São Paulo, Av. Prof. Lineu Prestes, 2565 - Cidade Universitária, 05508-000 - São Paulo - SP - Brasil, (16) 3307-2068, (16) 3307-2068 - São Paulo - SP - Brazil
E-mail: autopsy.hu@gmail.com

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[1] Authors’ contributions: Kamil Buczkowski wrote the manuscript, was responsible for the literature review, performed the autopsy, and participated in the histopathologic diagnosis. Irena Ożóg-Zabolska was responsible for the clinical care of the patient and supervised the manuscript. Jacek Gulczyński took the photographs during the autopsy and prepared them for the manuscript. Ewa Iżycka-Świeszewska supervised the manuscript and was responsible for histopathological diagnosis.