Buczkowski Kamil, Ożóg-Zabolska Irena, Gulczyński Jacek, Iżycka-Świeszewska Ewa
Szpital im. Mikołaja Kopernika (COPERNICUS PL), Department of Pathomorphology, Gdansk, Poland.
Gdański Uniwersytet Medyczny (GUMed), Department of Pathology and Neuropathology, Gdansk, Poland.
Autops Case Rep. 2022 Apr 14;12:e2021372. doi: 10.4322/acr.2021.372. eCollection 2022.
Hypoxic hepatitis is a rare complication of type 1 diabetes with unknown prevalence in Pediatrics. We present a case report of an 11-year-old boy admitted to the ER in the spring of 2020 (the beginning of the COVID19 pandemic in Poland) due to nausea, abdominal pain, and weight loss. A diagnosis of type 1 diabetes accompanied by severe ketoacidosis (pH 6.9, blood glucose 632mg/dl, ketone bodies in urine - 150mg/dl) was made. The hyperglycemia, ketoacidosis, and water-electrolyte disturbances were treated in the Pediatric Intensive Care Unit. On day 4, the boy developed fulminant septic shock with high aminotransferases (AST 9026 U/l, ALT 3559 U/l). CT scan revealed hepatic enlargement and steatosis. Acute viral hepatitis was suspected. The levels of anti-CMV IgM and IgG antibodies were slightly elevated. At autopsy, the liver was enlarged, with petechial bleedings on the surface. The liver parenchyma was congested, with signs of steatosis. Microscopically, there was extensive centrilobular necrosis, acute passive sinusoidal congestion, and steatosis of hepatocytes. There were no signs of CMV infection. Based on the entire clinicopathological picture, the patient was diagnosed with hypoxic hepatitis, complicated by septic shock and multiple organ failure.
缺氧性肝炎是1型糖尿病的一种罕见并发症，在儿科中的患病率未知。我们报告一例病例，一名11岁男孩于2020年春季（波兰新冠疫情开始时）因恶心、腹痛和体重减轻入住急诊室。诊断为1型糖尿病伴严重酮症酸中毒（pH 6.9，血糖632mg/dl，尿酮体-150mg/dl）。高血糖、酮症酸中毒和水电解质紊乱在儿科重症监护病房接受治疗。第4天，该男孩出现暴发性感染性休克，转氨酶升高（AST 9026 U/l，ALT 3559 U/l）。CT扫描显示肝脏肿大和脂肪变性。怀疑为急性病毒性肝炎。抗CMV IgM和IgG抗体水平略有升高。尸检时，肝脏肿大，表面有瘀点出血。肝实质充血，有脂肪变性迹象。显微镜下，有广泛的小叶中心坏死、急性被动性窦状隙充血和肝细胞脂肪变性。没有CMV感染的迹象。根据整个临床病理情况，该患者被诊断为缺氧性肝炎，并发感染性休克和多器官功能衰竭。
