MKH Chan, W Chiu

Rotavirus is a common aetiological agent of gastroenteritis and it has been documented that the infection can be associated with systemic disturbance. Previous reports have demonstrated a mild but significant elevation in hepatic transaminases. Liver involvement had also been demonstrated in animal models with immunocompromised as well as malnourished mice. This has also been demonstrated in a postmortem study of a series of 4 immunodeficient children. We report here a 7-month-old Chinese infant who had enjoyed good health since birth who developed a febrile illness associated with a rash. Examination revealed mild hepatomegaly and investigations showed neutropenia (190/μl) and marked elevation of hepatic transaminases (ALT 932 iu/l and AST 1287 iu/l). Other causes of viral hepatitis including hepatitis A and B, Epstein-Barr virus and cytomegalovirus were excluded by serological testing. The patient recovered uneventfully. Immunological work-up including total white cell count, CD4 and CD8 counts, CD4/CD8 ratio, immunoglobulin classes and CH5O in the classical and alternative pathways were all normal. To our knowledge derangement of hepatic transaminases of this degree has not before been reported in an immunocompetent human.