A 2-month-old male infant was admitted to the hospital at age 2 weeks with lethargy, a distended abdomen, and constipation. Hirschsprung's disease was suspected, and he underwent laparatomy with right-loop colostomy. The diagnosis was not confirmed. He developed postoperative peritonitis and septicemia, followed by acute renal failure necessitating peritoneal dialysis that was continued until he died 39 days later. Laboratory investigations on admission showed persistently elevated serum levels of aspartate aminotransferase, alanine aminotransferase, and total and direct bilirubin. Ratio of serum calcium to phosphate in 28 estimations was 1.9, which was normal, and intact parathormone level was 64 pg/mL. α1-Antitrypsin level was normal. Serum antibodies to hepatitis A, hepatitis B, Epstein-Barr virus, and cytomegalovirus were negative. Toxoplasmosis IgG antibody level was in the normal range. Liver failure was associated with uncorrectable coagulation parameters. Microscopic sections of the liver (Fig 1) and heart (Fig 2) are shown.
Greally JF, Torell A, Mack D, Gilbert-Barness E. SPECIAL FEATURE. Am J Dis Child. 1993;147(10):1125–1126. doi:10.1001/archpedi.1993.02160340111027
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