Liver and Bile
N Engl J Med. 2022;387(7):611–9
Clinical spectrum of children with acute hepatitis of unknown cause
Background: Since January 2022, there has been an increase in reports of cases of acute hepatitis of unknown cause in children. Although cases have been reported across multiple continents, most have been reported in the United Kingdom. Investigations are ongoing to identify the causative agent or agents.
Methods: The authors conducted a retrospective study involving children referred to a single pediatric liver-transplantation center in the UK between January 1, and April 11, 2022. These children were ≤ 10 years of age and had hepatitis that met the case definition of the UK Health Security Agency for confirmed acute hepatitis that was not hepatitis A through E and did not have a metabolic, inherited or genetic, congenital, or mechanical cause, in the context of a serum aminotransferase level > 500 IU/l. Medical records and documented demographic characteristics, clinical features, and results of liver biochemical, serologic, and molecular tests for hepatotropic and other viruses, as well as radiologic and clinical outcomes were reviewed. The outcomes were classified as an improving condition, liver transplantation, or death.
Results: A total of 44 children had hepatitis that met the confirmed case definition, and most were previously healthy. The median age was 4 (1–7) years. Common presenting features were jaundice (in 93% of the children), vomiting (in 54%), and diarrhea (in 32%). Among the 30 patients who underwent molecular testing for human adenovirus, 27 (90%) were positive. Fulminant liver failure developed in 6 patients (14%), all of whom received a liver transplant. None of the patients died. All the children, including the 6 who received liver transplants, were discharged home.
Conclusions: In this series involving 44 young children with acute hepatitis of uncertain cause, human adenovirus was isolated in most of the children, but its role in the pathogenesis of this illness has not been established.