Asia Pacific Journal of Pediatric and Child Health

Abstract Ref Number = APCP962

Poster Presentation

CHOLESTATIC HEPATITIS DUE TO SALMONELLA TYPHI CO-INFECTION IN AN EXPANDED DENGUE FEVER A CASE REPORT

Hafiidhaturrahmah Hafiidhaturrahmah,Wahyu Damayanti,Ida Safitri Laksanawati PPDS ILMU KESEHATAN ANAK UGM Division of Pediatric Gastroenterology and Hepatology, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah MadaDr Sardjito General Hospital, Yogyakarta, Indonesia Division of Pediatric Infectious Disease and Tropical, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah MadaDr Sardjito General Hospital, Yogyakarta, Indonesia

Background : Dengue infection is one of the major global health problems. Co-infections of dengue with typhoid fever increased risk of complications. Research in Delhi has reported dengue typhoid co-infection in 7.8% of their dengue cases. We reported a case of cholestatic hepatitis of typhoid fever in expanded dengue fever patient. Case Presentation Summary : A 13 years and 9 months-old boy was presented with fever and headache. Patient was treated at previous hospital from dengue hemorrhagic fever. Jaundice, abdominal tenderness, tea like urine and diarrhea were reported in day seven of fever. His laboratorium showed result of hemoglobin 11.7 g/dL, leukocyte 3.050/µL, platelet 41.000/µL, aspartate transaminase (AST) 160.2 U/L, alanine transaminase (ALT) 78.65 U/L, total bilirubin 5.85 mg/dL, and direct bilirubin 4.7 mg/dL. IgG and IgM typhoid was negative at admission to Dr Sardjito General Hospital. The patient was referred to our hospital on day ten of fever. On physical examination we found abdominal tenderness, hepatosplenomegaly, icteric, ascites, and minimal bilateral pleural effusion. Salmonella typhi was positive from blood culture. Negative serological and viral markers of acute viral hepatitis A, B and C. Serological marker for dengue indicated secondary infection as IgG was positive and negative for IgM. The procalsitonin level was 12.09 mg/dL. The abdominal and thoracal USG showed bilateral pleural effusion, hepatosplenomegaly, ascites, hydrops vesica felea of caused by sludge, and no cholecystitis. Antibiotics and cholestatic treatment such as ursodeoxycolate acid, A, D, E, K vitamins, and sistenol were administered. Patient was fully recovered with laboratorium of hemoglobin 9.5 g/dL, leukocyte 5.140/µL, platelet 323.000/µL, AST 46 U/L, ALT 42U/L, total bilirubin 2.09 mg/dL, direct bilirubin 1.71 mg/dL and procalcitonin 0.88 mg/dL.Patient discharged from hospital with oral antibiotic. Learning Points/Discussion : Dengue typhoid co-infection has clinical features such as jaundice, tea like urine, abdominal tenderness, hepatosplenomegaly, ascites and diarrhea. Management of cholestatis need to be performed to decrease the complications.

Keywords: Dengue Typhoid Cholestatic Hepatitis Salmonella typhii and children