34 TRANSACTIONS OF THE
ROYALSOCIETY OF TROPICAL
MEDICINE
AND HYGIENE (1992)
IShort Report 1 Fulminant hepatitis infant with visceral
in an Italian leishmaniasis
L. di Martino, P. Vajro, A. Nocerino, S. Scotti, G. Napolitano and A. Vegnente Department of Pediatrics, II Faculty of Medicine, Via S. Pan&i 5, 80131 Naples, Ita2y
Henaticinvolvement is freauent during visceralleishman&is; the liver is usually enlarged and contains numerous Kupffer cells laden with amastigotesand showslittle or no cellular reaction. In subclinicalcases, non-caseatinggranulomaswith few parasitesare scattered throughout the liver. Portal zone fibrosis may occur (OSTER & CHULAY, 1991).Hepatic function, however, is usuallyonly mildly affectedandrarely represents a major problemin the courseof the disease.Rarecases of cirrhosisand portal hypertensionhavebeenreported as a possibleeffect of associatedfactors suchas underlying malnutrition. Fulminant hepatitisdue to leishmaniasisis thought to be even more rare (KHALDI et al., 1990).Here we report a caseof fulminant hepatitisoccurring in an Italian infant with visceralleishmaniasis. Case report
C. V-was born on the island of Ischia (not far from Names)on 12Mav 1990from unrelatedhealthv uarents. Shewaswell until April 1991,when shepresemedwith fever and pancytopeniathat led to admissionto hospital in our department.Physicalexaminationshoweda sick, pale infant with intermittent fever but no jaundice.Her weight was 9.891 kg (W-75th percentile), her height was80 cm (90th percentile),and her weight/heightratio was in the 50-75th percentile. The liver was fiim and tender, palpable2 cm belowthe right costalmarginand the spleenwasenlarged,firm andpalpable10 cm below the left costal margin. Severe anaemia(haemoglobin 6.5 gidl), 1eucopenH(4400/mm3),and a low platelet count (66 OOO/mm3) were recorded.Liver function tests showed hypoalbuminaemia(2.5 gidl), hypergammaglobulinaemia(1.8 gidl), cytolysis (alanineaminotransferase [ALT], 108 mitt/ml; aspartateaminotransferase [AST], 205 miu/ml [normalvalues
ROYALSOCIETY OF TROPICAL
MEDICINE
AND HYGIENE (1992)
IShort Report 1 Fulminant hepatitis infant with visceral
in an Italian leishmaniasis
L. di Martino, P. Vajro, A. Nocerino, S. Scotti, G. Napolitano and A. Vegnente Department of Pediatrics, II Faculty of Medicine, Via S. Pan&i 5, 80131 Naples, Ita2y
Henaticinvolvement is freauent during visceralleishman&is; the liver is usually enlarged and contains numerous Kupffer cells laden with amastigotesand showslittle or no cellular reaction. In subclinicalcases, non-caseatinggranulomaswith few parasitesare scattered throughout the liver. Portal zone fibrosis may occur (OSTER & CHULAY, 1991).Hepatic function, however, is usuallyonly mildly affectedandrarely represents a major problemin the courseof the disease.Rarecases of cirrhosisand portal hypertensionhavebeenreported as a possibleeffect of associatedfactors suchas underlying malnutrition. Fulminant hepatitisdue to leishmaniasisis thought to be even more rare (KHALDI et al., 1990).Here we report a caseof fulminant hepatitisoccurring in an Italian infant with visceralleishmaniasis. Case report
C. V-was born on the island of Ischia (not far from Names)on 12Mav 1990from unrelatedhealthv uarents. Shewaswell until April 1991,when shepresemedwith fever and pancytopeniathat led to admissionto hospital in our department.Physicalexaminationshoweda sick, pale infant with intermittent fever but no jaundice.Her weight was 9.891 kg (W-75th percentile), her height was80 cm (90th percentile),and her weight/heightratio was in the 50-75th percentile. The liver was fiim and tender, palpable2 cm belowthe right costalmarginand the spleenwasenlarged,firm andpalpable10 cm below the left costal margin. Severe anaemia(haemoglobin 6.5 gidl), 1eucopenH(4400/mm3),and a low platelet count (66 OOO/mm3) were recorded.Liver function tests showed hypoalbuminaemia(2.5 gidl), hypergammaglobulinaemia(1.8 gidl), cytolysis (alanineaminotransferase [ALT], 108 mitt/ml; aspartateaminotransferase [AST], 205 miu/ml [normalvalues
