HEPATIC MANIFESTATIONS OF INFECTIOUS DISEASES. PRESENTATION OF CLINICAL CASE

Abstract

There are infectious diseases that produce alterations in liver function tests and histology, through the activation, by endotoxins and other agents of the innate immunity pathway. This work aims to review the hepatic manifestations of diseases such as dengue and brucellosis in the pediatric age by means of clinical cases. Case 1: 17-year-old male with a history of travel to an endemic area and family members positive for dengue. Fever, myalgias, arthralgias, arthralgias and headache. On admission with leukocytes 6.93 thousand, platelets 189 thousand and positive IgG and IgM antibodies for dengue fever. Physical examination with hepatodynia and petechiae in the pelvic limbs. In control biochemistry with leukopenia and moderate thrombocytopenia, as well as alterations in liver function (Table 1). Ultrasound of the liver with data of acute inflammatory process. Seven days after admission, with clinical and biochemical improvement, it was decided the discharge of the patient. Caso 2: male, four years nine months old, with symptoms of 1 month of evolution characterized by fever, hyporexia and general malaise. Physical examination with icteric-pale color, hepatomegaly of 3 × 5 × 7 cm and splenomegaly of 4 cm. Paraclinical tests showed anemia, leukopenia and mild-moderate thrombocytopenia, hypertransaminasemia, cholestasis and TTP prolongation (Table 2) with positive rose bengal, hepatic USG with hepatomegaly and echogenicity changes, for which he was sent to the third level of care. The mechanisms of liver injury can be divided into four pathways: vascular, toxic, immune and hormonal. In infections, the immune pathway is the cause of liver damage, being activated by endotoxins, leading to inflammatory infiltration, the release of cytokines, reactive oxygen species and necrosis. In dengue infection, liver injury manifests with hypertransaminasemia, with a peak between the seventh and ninth day, progressive decrease and normalization between 2 to 8 weeks. Hepatic involvement in brucellosis can occur in the acute or chronic phase of the disease. In the acute phase, establishing a non-specific granulomatous hepatitis, increasing in 63% of the cases the liver function tests. The functions of the liver and the relationships it establishes with other organs may favor its injury during some infectious pathologies, being at this level one of the first manifestations in the context of an infectious disease, ruling out, in both cases, liver pathology by hepatotropic virus, metabolic, autoimmune and anatomical cause. The authors declare that there is no conflict of interest.