Severe Acute Hepatitis in Children of Unknown Etiology

Abstract

Public health agencies have raised concern over cases of acute severe hepatitis of unknown etiology in children that have been reported worldwide. Surveillance has been implemented in several jurisdictions to identify cases, investigate etiologies and monitor trends to determine if there is a signal of concern. The relationship between the COVID-19 pandemic and the genesis of these reports is yet to be fully determined. Potential etiological hypotheses have included adenovirus and SARS-CoV-2 infection. However, to date, cases reported in the published literature have had inconsistent and incomplete testing sent, limiting the epidemiological investigation. Clinicians need to be aware of how to recognize severity of acute hepatitis in children, what investigations to perform, and threshold to refer to a pediatric gastroenterologist or a liver transplant center. This document summarizes a pathway for the evaluation of children with severe acute hepatitis of unknown etiology and highlights the importance of immediately consulting with a pediatric gastroenterologist if the INR is elevated (greater or equal to than 1.5) and/or serum direct bilirubin is elevated to prioritize investigations and guide management.