2239 Rotavirus, a Gastroenteritis Associated With Acute Transaminitis in Adult

Abstract

INTRODUCTION: Rotavirus gastroenteritis is commonly seen in the pediatric population. In contrast, the role of rotavirus in adults is far less reported. Infection typically presents as traveler’s diarrhea, in household members of affected children, and in outbreaks of gastroenteritis in vulnerable resident populations such as colleges and nursing homes. Laboratory findings are usually normal and mild elevations of serum transaminases may be seen during acute illness. The hepatic injury seen in adults and more severe elevations in transaminases have not been extensively reported. CASE DESCRIPTION/METHODS: We present a case of a 44-year-old female who presented to our emergency department with complaints of intractable vomiting, watery diarrhea and abdominal pain for a few hours. The patient had just returned to the United States from vacation in Mexico on the day prior to presentation. Patient was admitted for dehydration and symptomatic management. Laboratory workup was significant for leukocytosis of 17.400, normal hepatic transaminase and bilirubin. Gastrointestinal PCR panel was ordered and showed rotavirus A infection. On the next day, the patient noted to have significantly elevated transaminase with an AST of 504, an ALT of 444 with normal bilirubin and alkaline phosphatase. Transaminase continued to trend up and peaked the next morning at an AST of 689 and an ALT of 798. Acute hepatitis workup including HAV IgM, HBsAg, HBsAb, HCV antibody, HIV, EBV IgM, CMV IgM, and CK were all within normal limits. Ultrasound of the liver showed cholelithiasis without cholecystitis or common bile duct dilation. The patient was subsequently discharged the following day as transaminase started to trend down. Upon follow up a few days after discharge, laboratory workup showed near normal transaminase. DISCUSSION: We present a unique case of a middle aged female with travelers’ diarrhea due to Rotavirus A infection with moderately elevated transaminases. Transaminitis had been reported in literature but usually as only a mild elevation of transaminase. Rotavirus testing and diagnosis in the appropriate clinical setting can change management and prevent nosocomial spread. We would like to emphasize that viral gastroenteritis and specifically Rotavirus could be correlated to not only mild but also moderate and severe elevations of transaminases. Rotavirus A infection should be considered in the differential diagnosis of adults with acute gastroenteritis and elevated liver enzymes.